Jennifer Barrett - MyFlorida.com Exhibit F-5 SMMC LTC Population MMA Base Data Set Exhibit F-6 Data...

RICK SCOTT GOVERNOR Better Health Care for all Floridians ELIZABETH DUDEK

SECRETARY

Vis i t AHCA on l ine a t h t tp : / /ahca. my f lo r ida .com

2727 Mahan Dr i ve • Mai l S top #15 Ta l lahassee, FL 32308

December 28, 2012

Prospective Vendor: Subject: Solicitation Number: AHCA ITN 017-12/13

Title: Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA) – Region 1

This solicitation is being issued by the State of Florida, Agency for Health Care Administration, hereinafter referred to as AHCA or “Agency”, to select vendors to provide Managed Medical Assistance Services to Medicaid recipients for the SMMC program. The solicitation package consists of this transmittal letter and the following attachments: Attachment A PUR 1001, State of Florida General Instructions to Respondents Attachment B PUR 1000, State of Florida General Contract Conditions Attachment C Special Conditions and Instructions Exhibit C-1 Questions Template Instructions Exhibit C-2 Past Performance Client Reference Form Exhibit C-3 Required Certifications and Statements Exhibit C-4 Disclosure of Ownership and Control Interest Statement (CMS 1513) Exhibit C-5 Managed Medical Assistance (MMA) Provider Service Network (PSN) Provider

Ownership Interest Disclosure Report Exhibit C-6 List of Terminated Contracts Exhibit C-7 Vendor Certification Regarding Scrutinized Companies List Exhibit C-8 Home Medical Equipment and Supplies Providers List Exhibit C-9 Regional Preference Hierarchy Exhibit C-10 Certification of Drug Free Workplace Program Exhibit C-11 Standard Contract Attachment D Scope of Services - Core Provisions Exhibit D-1 Managed Medical Assistance Program Exhibit D-2 Long Term Care Program Attachment E Technical Proposal Instructions Exhibit E-1 Standard Submission Requirements and Evaluation Criteria Exhibit E-2 Standard Quality Measurement Tool Exhibit E-3 Provider Network File Exhibit E-4 Specialty Submission Requirements and Evaluation Criteria Exhibit E-5 Specialty Quality Measurement Tool Exhibit E-6 Respondent Attestation for Response Submission

Page Two Attachment F Cost Proposal Instructions Exhibit F-1 Statewide Medicaid Managed Care – Managed Medical Assistance Non-LTC

Population Rate Methodology Narrative Exhibit F-2 Base Data Set Non LTC Population Exhibit F-3 Inflation Factors Exhibit F-4 Statewide Medicaid Managed Care – Managed Medical Assistance LTC

Population Rate Methodology Narrative Exhibit F-5 SMMC LTC Population MMA Base Data Set Exhibit F-6 Data Books Exhibit F-7 Data Book Narratives Exhibit F-8 Summary of Supplemental Information Exhibit F-9 Supplemental Information Exhibit F-10 Capitated Plan Cost Proposal Exhibit F-11 Non-Capitated Cost Proposal Your response must comply fully with the instructions that stipulate what is to be included in the response. Prospective vendors submitting a response to this solicitation shall identify the solicitation number, date and time of opening on the envelope transmitting their response. This information is used only to put the AHCA mailroom on notice that the package received is a response to an AHCA solicitation and therefore should not be opened, but delivered directly to the Issuing Officer. The designated AHCA Issuing Officer for this solicitation is the undersigned. All communications from prospective vendors shall be made in writing and directed to my attention at the address provided in Attachment C, Special Conditions and Instructions, Section C.5, unless otherwise instructed in the ITN. The term “response” or “reply” may be used interchangeably and mean the prospective vendor’s submission to this ITN.

Sincerely,

Jennifer Barrett

Jennifer Barrett, Chief Bureau of Support Services

Attachments

AHCA ITN 017-12/13, Attachment A, Page 1 of 4

PUR 1001 (10/06) 60A-1.002(7), F.A.C.

ATTACHMENT A State of Florida

PUR 1001 General Instructions to Respondents

Contents 1. Definitions. 2. General Instructions. 3. Electronic Submission of Responses. 4. Terms and Conditions. 5. Questions. 6. Conflict of Interest. 7. Convicted Vendors. 8. Discriminatory Vendors. 9. Respondent’s Representation and Authorization. 10. Manufacturer’s Name and Approved Equivalents. 11. Performance Qualifications. 12. Public Opening. 13. Electronic Posting of Notice of Intended Award. 14. Firm Response. 15. Clarifications/Revisions. 16. Minor Irregularities/Right to Reject. 17. Contract Formation. 18. Contract Overlap. 19. Public Records. 20. Protests. 21. Limitation on Vendor Contact with Agency During Solicitation Period 1. Definitions. The definitions found in s. 60A-1.001, F.A.C. shall apply to this agreement. The following additional terms are also defined: (a) "Buyer" means the entity that has released the

solicitation. The “Buyer” may also be the “Customer” as defined in the PUR 1000 if that entity meets the definition of both terms.

(b) "Procurement Officer" means the Buyer's contracting personnel, as identified in the Introductory Materials.

(c) "Respondent" means the entity that submits materials to the Buyer in accordance with these Instructions.

(d) "Response" means the material submitted by the respondent in answering the solicitation.

(e) "Timeline" means the list of critical dates and actions included in the Introductory Materials.

2. General Instructions. Potential respondents to the solicitation are encouraged to carefully review all the materials contained herein and prepare responses accordingly. 3. Electronic Submission of Responses. Respondents are required to submit responses electronically. For this purpose, all references herein to signatures, signing requirements, or other required acknowledgments hereby include electronic signature by means of clicking the "Submit Response" button (or other similar symbol or process) attached to or logically associated with the response created by the respondent within MyFloridaMarketPlace. The respondent agrees that the action of electronically submitting its response constitutes:

• an electronic signature on the response, generally,

• an electronic signature on any form or section specifically calling for a signature, and

• an affirmative agreement to any statement contained in the solicitation that requires a definite confirmation or acknowledgement.

4. Terms and Conditions. All responses are subject to the terms of the following sections of this solicitation, which, in case of conflict, shall have the order of precedence listed:

• Technical Specifications, • Special Conditions and Instructions, • Instructions to Respondents (PUR 1001), • General Conditions (PUR 1000), and • Introductory Materials.

The Buyer objects to and shall not consider any additional terms or conditions submitted by a respondent, including any appearing in documents attached as part of a respondent’s response. In submitting its response, a respondent agrees that any additional terms or conditions, whether submitted intentionally or inadvertently, shall have no force or effect. Failure to comply with terms and conditions, including those specifying information that must be submitted with a response, shall be grounds for rejecting a response. 5. Questions. Respondents shall address all questions regarding this solicitation to the Procurement Officer. Questions must be submitted via the Q&A Board within MyFloridaMarketPlace and must be RECEIVED NO LATER THAN the time and date reflected on the Timeline. Questions shall be answered in accordance with the Timeline. All questions submitted shall be published and answered in a manner that all respondents will be able to view. Respondents shall not contact any other employee of the Buyer or the State for information with respect to this solicitation. Each respondent is responsible for monitoring the MyFloridaMarketPlace site for new or changing information. The Buyer shall not be bound by any verbal information or by any written information that is not contained within the solicitation documents or formally noticed and issued by the Buyer's contracting personnel. Questions to the Procurement Officer or to any Buyer personnel shall not constitute formal protest of the specifications or of the solicitation, a process addressed in paragraph 19 of these Instructions. 6. Conflict of Interest. This solicitation is subject to chapter 112 of the Florida Statutes. Respondents shall disclose with their response the name of any officer, director, employee or other agent who is also an employee of the State. Respondents shall also disclose the name of any State employee who owns, directly or indirectly, an interest of five percent (5%) or more in the respondent or its affiliates. 7. Convicted Vendors. A person or affiliate placed on the convicted vendor list following a conviction for a public entity crime is prohibited from doing any of the following for a period of 36 months from the date of being placed on the convicted vendor list:

• submitting a bid on a contract to provide any goods or services to a public entity;

• submitting a bid on a contract with a public entity for the construction or repair of a public building or public work;


PUR 1001 (10/06) 60A-1.002(7), F.A.C.

• submitting bids on leases of real property to a public entity;

• being awarded or performing work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity; and

• transacting business with any public entity in excess of the Category Two threshold amount ($25,000) provided in section 287.017 of the Florida Statutes.

8. Discriminatory Vendors. An entity or affiliate placed on the discriminatory vendor list pursuant to section 287.134 of the Florida Statutes may not:

• submit a bid on a contract to provide any goods or services to a public entity;

• submit a bid on a contract with a public entity for the construction or repair of a public building or public work;

• submit bids on leases of real property to a public entity;

• be awarded or perform work as a contractor, supplier, sub-contractor, or consultant under a contract with any public entity; or

• transact business with any public entity. 9. Respondent’s Representation and Authorization. In submitting a response, each respondent understands, represents, and acknowledges the following (if the respondent cannot so certify to any of following, the respondent shall submit with its response a written explanation of why it cannot do so).

• The respondent is not currently under suspension or debarment by the State or any other governmental authority.

• To the best of the knowledge of the person signing the response, the respondent, its affiliates, subsidiaries, directors, officers, and employees are not currently under investigation by any governmental authority and have not in the last ten (10) years been convicted or found liable for any act prohibited by law in any jurisdiction, involving conspiracy or collusion with respect to bidding on any public contract.

• Respondent currently has no delinquent obligations to the State, including a claim by the State for liquidated damages under any other contract.

• The submission is made in good faith and not pursuant to any agreement or discussion with, or inducement from, any firm or person to submit a complementary or other noncompetitive response.

• The prices and amounts have been arrived at independently and without consultation, communication, or agreement with any other respondent or potential respondent; neither the prices nor amounts, actual or approximate, have been disclosed to any respondent or potential respondent, and they will not be disclosed before the solicitation opening.

• The respondent has fully informed the Buyer in writing of all convictions of the firm, its affiliates (as defined in section 287.133(1)(a) of the Florida Statutes), and all directors,

officers, and employees of the firm and its affiliates for violation of state or federal antitrust laws with respect to a public contract for violation of any state or federal law involving fraud, bribery, collusion, conspiracy or material misrepresentation with respect to a public contract. This includes disclosure of the names of current employees who were convicted of contract crimes while in the employ of another company.

• Neither the respondent nor any person associated with it in the capacity of owner, partner, director, officer, principal, investigator, project director, manager, auditor, or position involving the administration of federal funds: o Has within the preceding three years

been convicted of or had a civil judgment rendered against them or is presently indicted for or otherwise criminally or civilly charged for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a federal, state, or local government transaction or public contract; violation of federal or state antitrust statutes; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; or

o Has within a three-year period preceding this certification had one or more federal, state, or local government contracts terminated for cause or default.

• The product offered by the respondent will conform to the specifications without exception.

• The respondent has read and understands the Contract terms and conditions, and the submission is made in conformance with those terms and conditions.

• If an award is made to the respondent, the respondent agrees that it intends to be legally bound to the Contract that is formed with the State.

• The respondent has made a diligent inquiry of its employees and agents responsible for preparing, approving, or submitting the response, and has been advised by each of them that he or she has not participated in any communication, consultation, discussion, agreement, collusion, act or other conduct inconsistent with any of the statements and representations made in the response.

• The respondent shall indemnify, defend, and hold harmless the Buyer and its employees against any cost, damage, or expense which may be incurred or be caused by any error in the respondent’s preparation of its bid.

• All information provided by, and representations made by, the respondent are material and important and will be relied upon by the Buyer in awarding the Contract. Any misstatement shall be treated as fraudulent concealment from the Buyer of the true facts


PUR 1001 (10/06) 60A-1.002(7), F.A.C.

relating to submission of the bid. A misrepresentation shall be punishable under law, including, but not limited to, Chapter 817 of the Florida Statutes.

10. Manufacturer’s Name and Approved Equivalents. Unless otherwise specified, any manufacturers’ names, trade names, brand names, information or catalog numbers listed in a specification are descriptive, not restrictive. With the Buyer’s prior approval, the Contractor may provide any product that meets or exceeds the applicable specifications. The Contractor shall demonstrate comparability, including appropriate catalog materials, literature, specifications, test data, etc. The Buyer shall determine in its sole discretion whether a product is acceptable as an equivalent. 11. Performance Qualifications. The Buyer reserves the right to investigate or inspect at any time whether the product, qualifications, or facilities offered by Respondent meet the Contract requirements. Respondent shall at all times during the Contract term remain responsive and responsible. In determining Respondent’s responsibility as a vendor, the agency shall consider all information or evidence which is gathered or comes to the attention of the agency which demonstrates the Respondent’s capability to fully satisfy the requirements of the solicitation and the contract. Respondent must be prepared, if requested by the Buyer, to present evidence of experience, ability, and financial standing, as well as a statement as to plant, machinery, and capacity of the respondent for the production, distribution, and servicing of the product bid. If the Buyer determines that the conditions of the solicitation documents are not complied with, or that the product proposed to be furnished does not meet the specified requirements, or that the qualifications, financial standing, or facilities are not satisfactory, or that performance is untimely, the Buyer may reject the response or terminate the Contract. Respondent may be disqualified from receiving awards if respondent, or anyone in respondent’s employment, has previously failed to perform satisfactorily in connection with public bidding or contracts. This paragraph shall not mean or imply that it is obligatory upon the Buyer to make an investigation either before or after award of the Contract, but should the Buyer elect to do so, respondent is not relieved from fulfilling all Contract requirements. 12. Public Opening. Responses shall be opened on the date and at the location indicated on the Timeline. Respondents may, but are not required to, attend. The Buyer may choose not to announce prices or release other materials pursuant to s. 119.071(1)(b), Florida Statutes. Any person requiring a special accommodation because of a disability should contact the Procurement Officer at least five (5) workdays prior to the solicitation opening. If you are hearing or speech impaired, please contact the Buyer by using the Florida Relay Service at (800) 955-8771 (TDD). 13. Electronic Posting of Notice of Intended Award. Based on the evaluation, on the date indicated on the Timeline the Buyer shall electronically post a notice of

intended award at http://fcn.state.fl.us/owa_vbs/owa/vbs_www.main_menu. If the notice of award is delayed, in lieu of posting the notice of intended award the Buyer shall post a notice of the delay and a revised date for posting the notice of intended award. Any person who is adversely affected by the decision shall file with the Buyer a notice of protest within 72 hours after the electronic posting. The Buyer shall not provide tabulations or notices of award by telephone. 14. Firm Response. The Buyer may make an award within sixty (60) days after the date of the opening, during which period responses shall remain firm and shall not be withdrawn. If award is not made within sixty (60) days, the response shall remain firm until either the Buyer awards the Contract or the Buyer receives from the respondent written notice that the response is withdrawn. Any response that expresses a shorter duration may, in the Buyer's sole discretion, be accepted or rejected. 15. Clarifications/Revisions. Before award, the Buyer reserves the right to seek clarifications or request any information deemed necessary for proper evaluation of submissions from all respondents deemed eligible for Contract award. Failure to provide requested information may result in rejection of the response. 16. Minor Irregularities/Right to Reject. The Buyer reserves the right to accept or reject any and all bids, or separable portions thereof, and to waive any minor irregularity, technicality, or omission if the Buyer determines that doing so will serve the State’s best interests. The Buyer may reject any response not submitted in the manner specified by the solicitation documents. 17. Contract Formation. The Buyer shall issue a notice of award, if any, to successful respondent(s), however, no contract shall be formed between respondent and the Buyer until the Buyer signs the Contract. The Buyer shall not be liable for any costs incurred by a respondent in preparing or producing its response or for any work performed before the Contract is effective. 18. Contract Overlap. Respondents shall identify any products covered by this solicitation that they are currently authorized to furnish under any state term contract. By entering into the Contract, a Contractor authorizes the Buyer to eliminate duplication between agreements in the manner the Buyer deems to be in its best interest. 19. Public Records. Article 1, section 24, Florida Constitution, guarantees every person access to all public records, and Section 119.011, Florida Statutes, provides a broad definition of public record. As such, all responses to a competitive solicitation are public records unless exempt by law. Any respondent claiming that its response contains information that is exempt from the public records law shall clearly segregate and mark that information and provide the specific statutory citation for such exemption. 20. Protests. Any protest concerning this solicitation shall be made in accordance with sections 120.57(3)

http://fcn.state.fl.us/owa_vbs/owa/vbs_www.main_menu

http://fcn.state.fl.us/owa_vbs/owa/vbs_www.main_menu


PUR 1001 (10/06) 60A-1.002(7), F.A.C.

and 287.042(2) of the Florida Statutes and chapter 28-110 of the Florida Administrative Code. Questions to the Procurement Officer shall not constitute formal notice of a protest. It is the Buyer's intent to ensure that specifications are written to obtain the best value for the State and that specifications are written to ensure competitiveness, fairness, necessity and reasonableness in the solicitation process. Section 120.57(3)(b), F.S. and Section 28-110.003, Fla. Admin. Code require that a notice of protest of the solicitation documents shall be made within seventy-two hours after the posting of the solicitation.

Section 120.57(3)(a), F.S. requires the following statement to be included in the solicitation: "Failure to file a protest within the time prescribed in section 120.57(3), Florida Statutes, shall constitute a waiver of proceedings under Chapter 120, Florida Statutes." Section 28-110.005, Fla. Admin. Code requires the following statement to be included in the solicitation: "Failure to file a protest within the time prescribed in Section 120.57(3), Florida Statutes, or failure to post the bond or other security required by law within the time allowed for filing a bond shall constitute a waiver of proceedings under Chapter 120, Florida Statutes.” 21. Limitation on Vendor Contact with Agency During Solicitation Period. Respondents to this solicitation or persons acting on their behalf may not contact, between the release of the solicitation and the end of the 72-hour period following the agency posting the notice of intended award, excluding Saturdays, Sundays, and state holidays, any employee or officer of the executive or legislative branch concerning any aspect of this solicitation, except in writing to the procurement officer or as provided in the solicitation documents. Violation of this provision may be grounds for rejecting a response.

AHCA ITN 017-12/13, Attachment B, Page 1 of 7 PUR 1000 (10/06) 60A-1.002, F.A.C.

ATTACHMENT B State of Florida

PUR 1000 General Contract Conditions

Contents 1. Definitions. 2. Purchase Orders. 3. Product Version. 4. Price Changes Applicable only to Term Contracts. 5. Additional Quantities. 6. Packaging. 7. Inspection at Contractor’s Site. 8. Safety Standards. 9. Americans with Disabilities Act. 10. Literature. 11. Transportation and Delivery. 12. Installation. 13. Risk of Loss. 14. Transaction Fee. 15. Invoicing and Payment. 16. Taxes. 17. Governmental Restrictions. 18. Lobbying and Integrity. 19. Indemnification. 20. Limitation of Liability. 21. Suspension of Work. 22. Termination for Convenience. 23. Termination for Cause. 24. Force Majeure, Notice of Delay, and No Damages for Delay. 25. Changes. 26. Renewal. 27. Purchase Order Duration. 28. Advertising. 29. Assignment. 30. Antitrust Assignment 31. Dispute Resolution. 32. Employees, Subcontractors, and Agents. 33. Security and Confidentiality. 34. Contractor Employees, Subcontractors, and Other Agents. 35. Insurance Requirements. 36. Warranty of Authority. 37. Warranty of Ability to Perform. 38. Notices. 39. Leases and Installment Purchases. 40. Prison Rehabilitative Industries and Diversified Enterprises, Inc. (PRIDE). 41. Products Available from the Blind or Other Handicapped. 42. Modification of Terms. 43. Cooperative Purchasing. 44. Waiver. 45. Annual Appropriations. 46. Execution in Counterparts. 47. Severability. 1. Definitions. The definitions contained in s. 60A-1.001, F.A.C. shall apply to this agreement. The following additional terms are also defined: (a) “Contract” means the legally enforceable agreement that results from a successful solicitation. The parties to the Contract will be the Customer and Contractor. (b) “Customer” means the State agency or other entity identified in a contract as the party to receive

commodities or contractual services pursuant to a contract or that orders commodities or contractual services via purchase order or other contractual instrument from the Contractor under the Contract. The “Customer” may also be the “Buyer” as defined in the PUR 1001 if it meets the definition of both terms. (c) “Product” means any deliverable under the Contract, which may include commodities, services, technology or software. (d) “Purchase order” means the form or format a Customer uses to make a purchase under the Contract (e.g., a formal written purchase order, electronic purchase order, procurement card, contract or other authorized means). 2. Purchase Orders. In contracts where commodities or services are ordered by the Customer via purchase order, Contractor shall not deliver or furnish products until a Customer transmits a purchase order. All purchase orders shall bear the Contract or solicitation number, shall be placed by the Customer directly with the Contractor, and shall be deemed to incorporate by reference the Contract and solicitation terms and conditions. Any discrepancy between the Contract terms and the terms stated on the Contractor’s order form, confirmation, or acknowledgement shall be resolved in favor of terms most favorable to the Customer. A purchase order for services within the ambit of section 287.058(1) of the Florida Statutes shall be deemed to incorporate by reference the requirements of subparagraphs (a) through (f) thereof. Customers shall designate a contract manager and a contract administrator as required by subsections 287.057(15) and (16) of the Florida Statutes. 3. Product Version. Purchase orders shall be deemed to reference a manufacturer’s most recently release model or version of the product at the time of the order, unless the Customer specifically requests in writing an earlier model or version and the contractor is willing to provide such model or version. 4. Price Changes Applicable only to Term Contracts. If this is a term contract for commodities or services, the following provisions apply. (a) Quantity Discounts. Contractors are urged to offer additional discounts for one time delivery of large single orders. Customers should seek to negotiate additional price concessions on quantity purchases of any products offered under the Contract. State Customers shall document their files accordingly. (b) Best Pricing Offer. During the Contract term, if the Customer becomes aware of better pricing offered by the Contractor for substantially the same or a smaller quantity of a product outside the Contract, but upon the same or similar terms of the Contract, then at the discretion of the Customer the price under the Contract shall be immediately reduced to the lower price. (c) Sales Promotions. In addition to decreasing prices for the balance of the Contract term due to a change in market conditions, a Contractor may conduct sales promotions involving price reductions for a specified lesser period. A Contractor shall submit to the Contract Specialist documentation identifying the proposed (1) starting and ending dates of the promotion, (2) products


involved, and (3) promotional prices compared to then-authorized prices. Promotional prices shall be available to all Customers. Upon approval, the Contractor shall provide conspicuous notice of the promotion. (d) Trade-In. Customers may trade-in equipment when making purchases from the Contract. A trade-in shall be negotiated between the Customer and the Contractor. Customers are obligated to actively seek current fair market value when trading equipment, and to keep accurate records of the process. For State agencies, it may be necessary to provide documentation to the Department of Financial Services and to the agency property custodian pursuant to Chapter 273, F.S. (e) Equitable Adjustment. The Customer may, in its sole discretion, make an equitable adjustment in the Contract terms or pricing if pricing or availability of supply is affected by extreme and unforeseen volatility in the marketplace, that is, by circumstances that satisfy all the following criteria: (1) the volatility is due to causes wholly beyond the Contractor’s control, (2) the volatility affects the marketplace or industry, not just the particular Contract source of supply, (3) the effect on pricing or availability of supply is substantial, and (4) the volatility so affects the Contractor that continued performance of the Contract would result in a substantial loss. 5. Additional Quantities. For a period not exceeding ninety (90) days from the date of solicitation award, the Customer reserves the right to acquire additional quantities up to the amount shown on the solicitation but not to exceed the threshold for Category Two at the prices submitted in the response to the solicitation. 6. Packaging. Tangible product shall be securely and properly packed for shipment, storage, and stocking in appropriate, clearly labeled, shipping containers and according to accepted commercial practice, without extra charge for packing materials, cases, or other types of containers. All containers and packaging shall become and remain Customer’s property. 7. Inspection at Contractor’s Site. The Customer reserves the right to inspect, at any reasonable time with prior notice, the equipment or product or plant or other facilities of a Contractor to assess conformity with Contract requirements and to determine whether they are adequate and suitable for proper and effective Contract performance. 8. Safety Standards. All manufactured items and fabricated assemblies subject to operation under pressure, operation by connection to an electric source, or operation involving connection to a manufactured, natural, or LP gas source shall be constructed and approved in a manner acceptable to the appropriate State inspector. Acceptability customarily requires, at a minimum, identification marking of the appropriate safety standard organization, where such approvals of listings have been established for the type of device offered and furnished, for example: the American Society of Mechanical Engineers for pressure vessels; the Underwriters Laboratories and/or National Electrical Manufacturers’ Association for electrically operated assemblies; and the American Gas Association for gas-

operated assemblies. In addition, all items furnished shall meet all applicable requirements of the Occupational Safety and Health Act and state and federal requirements relating to clean air and water pollution. 9. Americans with Disabilities Act. Contractors should identify any products that may be used or adapted for use by visually, hearing, or other physically impaired individuals. 10. Literature. Upon request, the Contractor shall furnish literature reasonably related to the product offered, for example, user manuals, price schedules, catalogs, descriptive brochures, etc. 11. Transportation and Delivery. Prices shall include all charges for packing, handling, freight, distribution, and inside delivery. Transportation of goods shall be FOB Destination to any point within thirty (30) days after the Customer places an Order. A Contractor, within five (5) days after receiving a purchase order, shall notify the Customer of any potential delivery delays. Evidence of inability or intentional delays shall be cause for Contract cancellation and Contractor suspension. 12. Installation. Where installation is required, Contractor shall be responsible for placing and installing the product in the required locations at no additional charge, unless otherwise designated on the Contract or purchase order. Contractor’s authorized product and price list shall clearly and separately identify any additional installation charges. All materials used in the installation shall be of good quality and shall be free of defects that would diminish the appearance of the product or render it structurally or operationally unsound. Installation includes the furnishing of any equipment, rigging, and materials required to install or replace the product in the proper location. Contractor shall protect the site from damage and shall repair damages or injury caused during installation by Contractor or its employees or agents. If any alteration, dismantling, excavation, etc., is required to achieve installation, the Contractor shall promptly restore the structure or site to its original condition. Contractor shall perform installation work so as to cause the least inconvenience and interference with Customers and with proper consideration of others on site. Upon completion of the installation, the location and surrounding area of work shall be left clean and in a neat and unobstructed condition, with everything in satisfactory repair and order. 13. Risk of Loss. Matters of inspection and acceptance are addressed in s. 215.422, F.S. Until acceptance, risk of loss or damage shall remain with the Contractor. The Contractor shall be responsible for filing, processing, and collecting all damage claims. To assist the Contractor with damage claims, the Customer shall: record any evidence of visible damage on all copies of the delivering carrier’s Bill of Lading; report damages to the carrier and the Contractor; and provide the Contractor with a copy of the carrier’s Bill of Lading and damage inspection report. When a Customer rejects a product, Contractor shall remove it from the premises within ten days after notification or rejection. Upon rejection notification, the risk of loss of rejected or non-conforming product shall remain with the Contractor. Rejected product not removed by the


Contractor within ten days shall be deemed abandoned by the Contractor, and the Customer shall have the right to dispose of it as its own property. Contractor shall reimburse the Customer for costs and expenses incurred in storing or effecting removal or disposition of rejected product.

14. Transaction Fee. The State of Florida has instituted MyFloridaMarketPlace, a statewide eProcurement System (“System”). Pursuant to section 287.057(23), Florida Statutes (2002), all payments shall be assessed a Transaction Fee of one percent (1.0%), which the Contractor shall pay to the State, unless exempt pursuant to 60A-1.032, F.A.C.

For payments within the State accounting system (FLAIR or its successor), the Transaction Fee shall, when possible, be automatically deducted from payments to the Contractor. If automatic deduction is not possible, the Contractor shall pay the Transaction Fee pursuant to Rule 60A-1.031(2), F.A.C. By submission of these reports and corresponding payments, Contractor certifies their correctness. All such reports and payments shall be subject to audit by the State or its designee.

Contractor shall receive a credit for any Transaction Fee paid by the Contractor for the purchase of any item(s) if such item(s) are returned to the Contractor through no fault, act, or omission of the Contractor. Notwithstanding the foregoing, a Transaction Fee is non-refundable when an item is rejected or returned, or declined, due to the Contractor’s failure to perform or comply with specifications or requirements of the agreement.

Failure to comply with these requirements shall constitute grounds for declaring the Contractor in default and recovering reprocurement costs from the Contractor in addition to all outstanding fees. CONTRACTORS DELINQUENT IN PAYING TRANSACTION FEES MAY BE SUBJECT TO BEING REMOVED FROM THE DEPARTMENT OF MANAGEMENT SERVICES’ VENDOR LIST AS PROVIDED IN RULE 60A-1.006, F.A.C. 15. Invoicing and Payment. Invoices shall contain the Contract number, purchase order number if applicable, and the appropriate vendor identification number. The State may require any other information from the Contractor that the State deems necessary to verify any purchase order placed under the Contract.

At the State's option, Contractors may be required to invoice electronically pursuant to guidelines of the Department of Management Services. Current guidelines require that Contractor supply electronic invoices in lieu of paper-based invoices for those transactions processed through the system. Electronic invoices shall be submitted to the Customer through the Ariba Supplier Network (ASN) in one of the following mechanisms – EDI 810, cXML, or web-based invoice entry within the ASN.

Payment shall be made in accordance with sections 215.422 and 287.0585 of the Florida Statutes, which govern time limits for payment of invoices. Invoices that must be returned to a Contractor due to preparation errors will result in a delay in payment. Contractors may call (850) 413-7269 Monday through Friday to inquire about the status of payments by State Agencies. The Customer is responsible for all payments under the

Contract. A Customer’s failure to pay, or delay in payment, shall not constitute a breach of the Contract and shall not relieve the Contractor of its obligations to the Department or to other Customers.

16. Taxes. The State does not pay Federal excise or sales taxes on direct purchases of tangible personal property. The State will not pay for any personal property taxes levied on the Contractor or for any taxes levied on employees’ wages. Any exceptions to this paragraph shall be explicitly noted by the Customer in the special contract conditions section of the solicitation or in the Contract or purchase order. 17. Governmental Restrictions. If the Contractor believes that any governmental restrictions have been imposed that require alteration of the material, quality, workmanship or performance of the products offered under the Contract, the Contractor shall immediately notify the Customer in writing, indicating the specific restriction. The Customer reserves the right and the complete discretion to accept any such alteration or to cancel the Contract at no further expense to the Customer. 18. Lobbying and Integrity. Customers shall ensure compliance with Section 11.062, FS and Section 216.347, FS.The Contractor shall not, in connection with this or any other agreement with the State, directly or indirectly (1) offer, confer, or agree to confer any pecuniary benefit on anyone as consideration for any State officer or employee’s decision, opinion, recommendation, vote, other exercise of discretion, or violation of a known legal duty, or (2) offer, give, or agree to give to anyone any gratuity for the benefit of, or at the direction or request of, any State officer or employee. For purposes of clause (2), “gratuity” means any payment of more than nominal monetary value in the form of cash, travel, entertainment, gifts, meals, lodging, loans, subscriptions, advances, deposits of money, services, employment, or contracts of any kind. Upon request of the Customer’s Inspector General, or other authorized State official, the Contractor shall provide any type of information the Inspector General deems relevant to the Contractor’s integrity or responsibility. Such information may include, but shall not be limited to, the Contractor’s business or financial records, documents, or files of any type or form that refer to or relate to the Contract. The Contractor shall retain such records for the longer of (1) three years after the expiration of the Contract or (2) the period required by the General Records Schedules maintained by the Florida Department of State (available at: http://dlis.dos.state.fl.us/barm/genschedules/gensched.htm). The Contractor agrees to reimburse the State for the reasonable costs of investigation incurred by the Inspector General or other authorized State official for investigations of the Contractor’s compliance with the terms of this or any other agreement between the Contractor and the State which results in the suspension or debarment of the Contractor. Such costs shall include, but shall not be limited to: salaries of investigators, including overtime; travel and lodging expenses; and expert witness and documentary fees. The Contractor shall not be responsible for any costs of investigations that do not result in the Contractor’s suspension or debarment.

19. Indemnification. The Contractor shall be fully liable for the actions of its agents, employees, partners, or subcontractors and shall fully indemnify, defend, and

http://dlis.dos.state.fl.us/barm/genschedules/gensched.htm

http://dlis.dos.state.fl.us/barm/genschedules/gensched.htm


hold harmless the State and Customers, and their officers, agents, and employees, from suits, actions, damages, and costs of every name and description, including attorneys’ fees, arising from or relating to personal injury and damage to real or personal tangible property alleged to be caused in whole or in part by Contractor, its agents, employees, partners, or subcontractors, provided, however, that the Contractor shall not indemnify for that portion of any loss or damages proximately caused by the negligent act or omission of the State or a Customer. Further, the Contractor shall fully indemnify, defend, and hold harmless the State and Customers from any suits, actions, damages, and costs of every name and description, including attorneys’ fees, arising from or relating to violation or infringement of a trademark, copyright, patent, trade secret or intellectual property right, provided, however, that the foregoing obligation shall not apply to a Customer’s misuse or modification of Contractor’s products or a Customer’s operation or use of Contractor’s products in a manner not contemplated by the Contract or the purchase order. If any product is the subject of an infringement suit, or in the Contractor’s opinion is likely to become the subject of such a suit, the Contractor may at its sole expense procure for the Customer the right to continue using the product or to modify it to become non-infringing. If the Contractor is not reasonably able to modify or otherwise secure the Customer the right to continue using the product, the Contractor shall remove the product and refund the Customer the amounts paid in excess of a reasonable rental for past use. The customer shall not be liable for any royalties. The Contractor’s obligations under the preceding two paragraphs with respect to any legal action are contingent upon the State or Customer giving the Contractor (1) written notice of any action or threatened action, (2) the opportunity to take over and settle or defend any such action at Contractor’s sole expense, and (3) assistance in defending the action at Contractor’s sole expense. The Contractor shall not be liable for any cost, expense, or compromise incurred or made by the State or Customer in any legal action without the Contractor’s prior written consent, which shall not be unreasonably withheld. 20. Limitation of Liability. For all claims against the Contractor under any contract or purchase order, and regardless of the basis on which the claim is made, the Contractor’s liability under a contract or purchase order for direct damages shall be limited to the greater of $100,000, the dollar amount of the contract or purchase order, or two times the charges rendered by the Contractor under the purchase order. This limitation shall not apply to claims arising under the Indemnity paragraph contain in this agreement. Unless otherwise specifically enumerated in the Contract or in the purchase order, no party shall be liable to another for special, indirect, punitive, or consequential damages, including lost data or records (unless the contract or purchase order requires the Contractor to back-up data or records), even if the party has been advised that such damages are possible. No party shall be liable for lost profits, lost revenue, or lost institutional operating savings. The State and Customer may, in addition to other remedies available to them at law or equity and upon notice to the

Contractor, retain such monies from amounts due Contractor as may be necessary to satisfy any claim for damages, penalties, costs and the like asserted by or against them. The State may set off any liability or other obligation of the Contractor or its affiliates to the State against any payments due the Contractor under any contract with the State. 21. Suspension of Work. The Customer may in its sole discretion suspend any or all activities under the Contract or purchase order, at any time, when in the best interests of the State to do so. The Customer shall provide the Contractor written notice outlining the particulars of suspension. Examples of the reason for suspension include, but are not limited to, budgetary constraints, declaration of emergency, or other such circumstances. After receiving a suspension notice, the Contractor shall comply with the notice and shall not accept any purchase orders. Within ninety days, or any longer period agreed to by the Contractor, the Customer shall either (1) issue a notice authorizing resumption of work, at which time activity shall resume, or (2) terminate the Contract or purchase order. Suspension of work shall not entitle the Contractor to any additional compensation. 22. Termination for Convenience. The Customer, by written notice to the Contractor, may terminate the Contract in whole or in part when the Customer determines in its sole discretion that it is in the State’s interest to do so. The Contractor shall not furnish any product after it receives the notice of termination, except as necessary to complete the continued portion of the Contract, if any. The Contractor shall not be entitled to recover any cancellation charges or lost profits. 23. Termination for Cause. The Customer may terminate the Contract if the Contractor fails to (1) deliver the product within the time specified in the Contract or any extension, (2) maintain adequate progress, thus endangering performance of the Contract, (3) honor any term of the Contract, or (4) abide by any statutory, regulatory, or licensing requirement. Rule 60A-1.006(3), F.A.C., governs the procedure and consequences of default. The Contractor shall continue work on any work not terminated. Except for defaults of subcontractors at any tier, the Contractor shall not be liable for any excess costs if the failure to perform the Contract arises from events completely beyond the control, and without the fault or negligence, of the Contractor. If the failure to perform is caused by the default of a subcontractor at any tier, and if the cause of the default is completely beyond the control of both the Contractor and the subcontractor, and without the fault or negligence of either, the Contractor shall not be liable for any excess costs for failure to perform, unless the subcontracted products were obtainable from other sources in sufficient time for the Contractor to meet the required delivery schedule. If, after termination, it is determined that the Contractor was not in default, or that the default was excusable, the rights and obligations of the parties shall be the same as if the termination had been issued for the convenience of the Customer. The rights and remedies of the Customer in this clause are in addition to any other rights and remedies provided by law or under the Contract.


24. Force Majeure, Notice of Delay, and No Damages for Delay. The Contractor shall not be responsible for delay resulting from its failure to perform if neither the fault nor the negligence of the Contractor or its employees or agents contributed to the delay and the delay is due directly to acts of God, wars, acts of public enemies, strikes, fires, floods, or other similar cause wholly beyond the Contractor’s control, or for any of the foregoing that affect subcontractors or suppliers if no alternate source of supply is available to the Contractor. In case of any delay the Contractor believes is excusable, the Contractor shall notify the Customer in writing of the delay or potential delay and describe the cause of the delay either (1) within ten (10) days after the cause that creates or will create the delay first arose, if the Contractor could reasonably foresee that a delay could occur as a result, or (2) if delay is not reasonably foreseeable, within five (5) days after the date the Contractor first had reason to believe that a delay could result. THE FOREGOING SHALL CONSTITUTE THE CONTRACTOR’S SOLE REMEDY OR EXCUSE WITH RESPECT TO DELAY. Providing notice in strict accordance with this paragraph is a condition precedent to such remedy. No claim for damages, other than for an extension of time, shall be asserted against the Customer. The Contractor shall not be entitled to an increase in the Contract price or payment of any kind from the Customer for direct, indirect, consequential, impact or other costs, expenses or damages, including but not limited to costs of acceleration or inefficiency, arising because of delay, disruption, interference, or hindrance from any cause whatsoever. If performance is suspended or delayed, in whole or in part, due to any of the causes described in this paragraph, after the causes have ceased to exist the Contractor shall perform at no increased cost, unless the Customer determines, in its sole discretion, that the delay will significantly impair the value of the Contract to the State or to Customers, in which case the Customer may (1) accept allocated performance or deliveries from the Contractor, provided that the Contractor grants preferential treatment to Customers with respect to products subjected to allocation, or (2) purchase from other sources (without recourse to and by the Contractor for the related costs and expenses) to replace all or part of the products that are the subject of the delay, which purchases may be deducted from the Contract quantity, or (3) terminate the Contract in whole or in part. 25. Changes. The Customer may unilaterally require, by written order, changes altering, adding to, or deducting from the Contract specifications, provided that such changes are within the general scope of the Contract. The Customer may make an equitable adjustment in the Contract price or delivery date if the change affects the cost or time of performance. Such equitable adjustments require the written consent of the Contractor, which shall not be unreasonably withheld. If unusual quantity requirements arise, the Customer may solicit separate bids to satisfy them. 26. Renewal. Upon mutual agreement, the Customer and the Contractor may renew the Contract, in whole or in part, for a period that may not exceed 3 years or the term of the contract, whichever period is longer. Any renewal shall specify the renewal price, as set forth in the solicitation response. The renewal must be in writing and signed by both parties, and is contingent

upon satisfactory performance evaluations and subject to availability of funds. 27. Purchase Order Duration. Purchase orders issued pursuant to a state term or agency contract must be received by the Contractor no later than close of business on the last day of the contract’s term to be considered timely. The Contractor is obliged to fill those orders in accordance with the contract’s terms and conditions. Purchase orders received by the contractor after close of business on the last day of the state term or agency contract’s term shall be considered void. Purchase orders for a one-time delivery of commodities or performance of contractual services shall be valid through the performance by the Contractor, and all terms and conditions of the state term or agency contract shall apply to the single delivery/performance, and shall survive the termination of the Contract. Contractors are required to accept purchase orders specifying delivery schedules exceeding the contracted schedule even when such extended delivery will occur after expiration of the state term or agency contract. For example, if a state term contract calls for delivery 30 days after receipt of order (ARO), and an order specifies delivery will occur both in excess of 30 days ARO and after expiration of the state term contract, the Contractor will accept the order. However, if the Contractor expressly and in writing notifies the ordering office within ten (10) calendar days of receipt of the purchase order that Contractor will not accept the extended delivery terms beyond the expiration of the state term contract, then the purchase order will either be amended in writing by the ordering entity within ten (10) calendar days of receipt of the contractor’s notice to reflect the state term contract delivery schedule, or it shall be considered withdrawn. The duration of purchase orders for recurring deliveries of commodities or performance of services shall not exceed the expiration of the state term or agency contract by more than twelve months. However, if an extended pricing plan offered in the state term or agency contract is selected by the ordering entity, the contract terms on pricing plans and renewals shall govern the maximum duration of purchase orders reflecting such pricing plans and renewals. Timely purchase orders shall be valid through their specified term and performance by the Contractor, and all terms and conditions of the state term or agency contract shall apply to the recurring delivery/performance as provided herein, and shall survive the termination of the Contract. Ordering offices shall not renew a purchase order issued pursuant to a state term or agency contract if the underlying contract expires prior to the effective date of the renewal. 28. Advertising. Subject to Chapter 119, Florida Statutes, the Contractor shall not publicly disseminate any information concerning the Contract without prior written approval from the Customer, including, but not limited to mentioning the Contract in a press release or other promotional material, identifying the Customer or the State as a reference, or otherwise linking the Contractor’s name and either a description of the


Contract or the name of the State or the Customer in any material published, either in print or electronically, to any entity that is not a party to Contract, except potential or actual authorized distributors, dealers, resellers, or service representative. 29. Assignment. The Contractor shall not sell, assign or transfer any of its rights, duties or obligations under the Contract, or under any purchase order issued pursuant to the Contract, without the prior written consent of the Customer. In the event of any assignment, the Contractor remains secondarily liable for performance of the contract, unless the Customer expressly waives such secondary liability. The Customer may assign the Contract with prior written notice to Contractor of its intent to do so. 30. Antitrust Assignment. The Contractor and the State of Florida recognize that in actual economic practice, overcharges resulting from antitrust violations are in fact usually borne by the State of Florida. Therefore, the contractor hereby assigns to the State of Florida any and all claims for such overcharges as to goods, materials or services purchased in connection with the Contract. 31. Dispute Resolution. Any dispute concerning performance of the Contract shall be decided by the Customer's designated contract manager, who shall reduce the decision to writing and serve a copy on the Contractor. The decision shall be final and conclusive unless within twenty one (21) days from the date of receipt, the Contractor files with the Customer a petition for administrative hearing. The Customer’s decision on the petition shall be final, subject to the Contractor’s right to review pursuant to Chapter 120 of the Florida Statutes. Exhaustion of administrative remedies is an absolute condition precedent to the Contractor's ability to pursue any other form of dispute resolution; provided, however, that the parties may employ the alternative dispute resolution procedures outlined in Chapter 120. Without limiting the foregoing, the exclusive venue of any legal or equitable action that arises out of or relates to the Contract shall be the appropriate state court in Leon County, Florida; in any such action, Florida law shall apply and the parties waive any right to jury trial. 32. Employees, Subcontractors, and Agents. All Contractor employees, subcontractors, or agents performing work under the Contract shall be properly trained technicians who meet or exceed any specified training qualifications. Upon request, Contractor shall furnish a copy of technical certification or other proof of qualification. All employees, subcontractors, or agents performing work under the Contract must comply with all security and administrative requirements of the Customer and shall comply with all controlling laws and regulations relevant to the services they are providing under the Contract. The State may conduct, and the Contractor shall cooperate in, a security background check or otherwise assess any employee, subcontractor, or agent furnished by the Contractor. The State may refuse access to, or require replacement of, any personnel for cause, including, but not limited to, technical or training qualifications, quality of work, change in security status, or non-compliance with a Customer’s security or other requirements. Such approval shall not relieve the Contractor of its obligation

to perform all work in compliance with the Contract. The State may reject and bar from any facility for cause any of the Contractor’s employees, subcontractors, or agents. 33. Security and Confidentiality. The Contractor shall comply fully with all security procedures of the United States, State of Florida and Customer in performance of the Contract. The Contractor shall not divulge to third parties any confidential information obtained by the Contractor or its agents, distributors, resellers, subcontractors, officers or employees in the course of performing Contract work, including, but not limited to, security procedures, business operations information, or commercial proprietary information in the possession of the State or Customer. The Contractor shall not be required to keep confidential information or material that is publicly available through no fault of the Contractor, material that the Contractor developed independently without relying on the State’s or Customer’s confidential information, or material that is otherwise obtainable under State law as a public record. To insure confidentiality, the Contractor shall take appropriate steps as to its personnel, agents, and subcontractors. The warranties of this paragraph shall survive the Contract. 34.Contractor Employees, Subcontractors, and Other Agents. The Customer and the State shall take all actions necessary to ensure that Contractor's employees, subcontractors and other agents are not employees of the State of Florida. Such actions include, but are not limited to, ensuring that Contractor's employees, subcontractors, and other agents receive benefits and necessary insurance (health, workers' compensations, and unemployment) from an employer other than the State of Florida. 35. Insurance Requirements. During the Contract term, the Contractor at its sole expense shall provide commercial insurance of such a type and with such terms and limits as may be reasonably associated with the Contract. Providing and maintaining adequate insurance coverage is a material obligation of the Contractor. Upon request, the Contractor shall provide certificate of insurance. The limits of coverage under each policy maintained by the Contractor shall not be interpreted as limiting the Contractor’s liability and obligations under the Contract. All insurance policies shall be through insurers authorized or eligible to write policies in Florida. 36. Warranty of Authority. Each person signing the Contract warrants that he or she is duly authorized to do so and to bind the respective party to the Contract. 37. Warranty of Ability to Perform. The Contractor warrants that, to the best of its knowledge, there is no pending or threatened action, proceeding, or investigation, or any other legal or financial condition, that would in any way prohibit, restrain, or diminish the Contractor’s ability to satisfy its Contract obligations. The Contractor warrants that neither it nor any affiliate is currently on the convicted vendor list maintained pursuant to section 287.133 of the Florida Statutes, or on any similar list maintained by any other state or the federal government. The Contractor shall immediately notify the Customer in writing if its ability to perform is compromised in any manner during the term of the Contract.


38. Notices. All notices required under the Contract shall be delivered by certified mail, return receipt requested, by reputable air courier service, or by personal delivery to the agency designee identified in the original solicitation, or as otherwise identified by the Customer. Notices to the Contractor shall be delivered to the person who signs the Contract. Either designated recipient may notify the other, in writing, if someone else is designated to receive notice.

39. Leases and Installment Purchases. Prior approval of the Chief Financial Officer (as defined in Section 17.001, F.S.) is required for State agencies to enter into or to extend any lease or installment-purchase agreement in excess of the Category Two amount established by section 287.017 of the Florida Statutes.

40. Prison Rehabilitative Industries and Diversified Enterprises, Inc. (PRIDE). Section 946.515(2), F.S. requires the following statement to be included in the solicitation: "It is expressly understood and agreed that any articles which are the subject of, or required to carry out, the Contract shall be purchased from the corporation identified under Chapter 946 of the Florida Statutes (PRIDE) in the same manner and under the same procedures set forth in section 946.515(2) and (4) of the Florida Statutes; and for purposes of the Contract the person, firm, or other business entity carrying out the provisions of the Contract shall be deemed to be substituted for the agency insofar as dealings with such corporation are concerned." Additional information about PRIDE and the products it offers is available at http://www.pridefl.com. 41. Products Available from the Blind or Other Handicapped. Section 413.036(3), F.S. requires the following statement to be included in the solicitation: "It is expressly understood and agreed that any articles that are the subject of, or required to carry out, this contract shall be purchased from a nonprofit agency for the Blind or for the Severely Handicapped that is qualified pursuant to Chapter 413, Florida Statutes, in the same manner and under the same procedures set forth in section 413.036(1) and (2), Florida Statutes; and for purposes of this contract the person, firm, or other business entity carrying out the provisions of this contract shall be deemed to be substituted for the State agency insofar as dealings with such qualified nonprofit agency are concerned." Additional information about the designated nonprofit agency and the products it offers is available at http://www.respectofflorida.org. 42. Modification of Terms. The Contract contains all the terms and conditions agreed upon by the parties, which terms and conditions shall govern all transactions between the Customer and the Contractor. The Contract may only be modified or amended upon mutual written agreement of the Customer and the Contractor. No oral agreements or representations shall be valid or binding upon the Customer or the Contractor. No alteration or modification of the Contract terms, including substitution of product, shall be valid or binding against the Customer. The Contractor may not unilaterally modify the terms of the Contract by affixing additional terms to product upon delivery (e.g., attachment or inclusion of standard preprinted forms, product literature, “shrink wrap” terms accompanying or affixed to a product, whether written or electronic) or by incorporating such terms onto the Contractor’s order or fiscal forms or other documents

forwarded by the Contractor for payment. The Customer's acceptance of product or processing of documentation on forms furnished by the Contractor for approval or payment shall not constitute acceptance of the proposed modification to terms and conditions. 43. Cooperative Purchasing. Pursuant to their own governing laws, and subject to the agreement of the Contractor, other entities may be permitted to make purchases at the terms and conditions contained herein. Non-Customer purchases are independent of the agreement between Customer and Contractor, and Customer shall not be a party to any transaction between the Contractor and any other purchaser. State agencies wishing to make purchases from this agreement are required to follow the provisions of s. 287.042(16)(a), F.S. This statute requires the Department of Management Services to determine that the requestor's use of the contract is cost-effective and in the best interest of the State. 44. Waiver. The delay or failure by the Customer to exercise or enforce any of its rights under this Contract shall not constitute or be deemed a waiver of the Customer’s right thereafter to enforce those rights, nor shall any single or partial exercise of any such right preclude any other or further exercise thereof or the exercise of any other right. 45. Annual Appropriations. The State’s performance and obligation to pay under this contract are contingent upon an annual appropriation by the Legislature. 46. Execution in Counterparts. The Contract may be executed in counterparts, each of which shall be an original and all of which shall constitute but one and the same instrument. 47. Severability. If a court deems any provision of the Contract void or unenforceable, that provision shall be enforced only to the extent that it is not in violation of law or is not otherwise unenforceable and all other provisions shall remain in full force and effect.

http://www.pridefl.com/

http://www.respectofflorida.org/

ATTACHMENT C SPECIAL CONDITIONS AND INSTRUCTIONS

AHCA ITN 017-12/13, Attachment C, Page 1 of 47

Section I. Procurement Instructions

A. Procurement Overview 1. Solicitation Number: AHCA ITN 017-12/13

2. Solicitation Type: Invitation to Negotiate (ITN)

3. Solicitation Title: Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA) – Region 1 4. Date of Issuance: December 28, 2012

5. Issuing Officer: Jennifer Barrett Agency for Health Care Administration Building 2, Suite 203, Mail Stop 15 2727 Mahan Drive Tallahassee, FL 32308-5403 Fax # 850-488-0317 Email: [email protected]

6. Solicitation Timeline

The projected solicitation timeline is shown below (all times are Eastern Time). The Agency reserves the right to amend the timeline in the State’s best interest. If the Agency finds it necessary to change any of the activities/dates/times listed (other than “anticipated”), all interested parties will be notified by addenda to the original solicitation document posted on the Vendor Bid System (VBS) (http://myflorida.com/apps/vbs/vbs_www.main_menu).

ACTIVITY DATE/TIME LOCATION

Solicitation Issued by Agency

December 28, 2012 Electronically Posted

http://myflorida.com/apps/vbs/vbs_www.main_menu

Deadline for Receipt of Written Inquiries

January 22, 2013 @ 5:00 PM

[email protected] 2727 Mahan Drive, MS# 15 Tallahassee, FL 32308-5403

Vendor Conference for Regions 1 – 11

February 12, 2013 @ 9:00 AM

2727 Mahan Drive, Building 3 AHCA Conference Room A, 1st Floor

Tallahassee, FL 32308-5403

mailto:[email protected]






Anticipated date for Agency Responses to Written Inquiries

February 26, 2013

Electronically Posted http://myflorida.com/apps/vbs/vbs_www.main_menu

Deadline for Receipt of Responses

March 15, 2013 @ 2:00 PM

2727 Mahan Drive, MS# 15 Building 2, 3rd Floor, Suite 333

Conference Room F Tallahassee, FL 32308-5403

Public Opening of Responses

March 18, 2013 @ 8:30 AM

2727 Mahan Drive, MS# 15 Building 2, 3rd Floor, Suite 333

Conference Room F Tallahassee, FL 32308-5403

Publish List of Respondents for

Provider Comments

March 20, 2013

Electronically Posted http://ahca.myflorida.com/medicaid/statewide_mc/index.shtml

Anticipated Dates for Negotiations

July 1, 2013 – August 20, 2013

2727 Mahan Drive, MS# 15 Building 2, 2nd Floor, Suite 200 Operations Conference Room Tallahassee, FL 32308-5403

Anticipated Posting of Notice of Intent to

Award September 16, 2013

Electronically Posted http://myflorida.com/apps/vbs/vbs_www.main_menu

Anticipated Contract Execution Date December 31, 2013

7. Restriction on Communications

Respondents to this ITN or persons acting on their behalf may not contact, between the release of the ITN and the end of the seventy-two (72) hour period following the Agency posting the notice of intended award, excluding Saturdays, Sundays, and state holidays, any employee or officer of the executive or legislative branch concerning any aspect of this ITN, except in writing to the Issuing Officer or as provided in the ITN documents. VIOLATION OF THIS PROVISION MAY BE GROUNDS FOR REJECTING A RESPONSE.

8. Vendor Questions

Note: This Special Instruction takes precedence over Attachment A, General Instructions to Respondents, #5, Questions.


http://ahca.myflorida.com/medicaid/statewide_mc/index.shtml




The Agency will receive all questions pertaining to this ITN no later than the date and time specified for written inquiries in Section I.A.6, Solicitation Timeline. All inquiries must be made in writing and if sent by email, questions shall be submitted to [email protected]. Questions may be sent by U.S. Mail, email, fax or hand delivered. Email is preferred and encouraged. No telephone inquiries will be accepted. Prospective vendors shall utilize Exhibit C-1, Questions Template Instructions, when submitting a written inquiry.

The Agency reserves the right to consider questions received after the submission deadline on a case-by-case basis. If the Agency, in its sole discretion, determines that all prospective vendors would benefit from a response, an addendum to this ITN will be issued and posted to the VBS. The Agency’s response to questions received for all Regions will be posted as specified in Section I.A.6, Solicitation Timeline, as an addendum to this ITN and may be grouped as to not repeat the same answer multiple times.

9. Vendor’s Conference

To assure understanding, the Agency will hold one (1) simultaneous, non-mandatory vendor’s conference for all Regions of the State, on the date and time indicated in Section I.A.6, Solicitation Timeline. Although the vendor’s conference is not mandatory, prospective vendors are strongly encouraged to participate. The purpose of this conference is to convey the Agency’s concept of the services requested under this ITN and to answer appropriate legal, administrative, and/or technical questions. The Agency will provide responses to written questions received in accordance with Section I.A.8, Vendor Questions, during the conference, and will also accept oral questions. The Agency will make a reasonable effort to provide answers to oral questions at that time. However, oral answers and discussions are not binding on the Agency. Only those communications, which are in writing from the Agency, may be considered as duly authorized expressions on behalf of the State. Any person requiring a special accommodation because of a disability should contact the Issuing Officer at least five (5) workdays prior to the vendor’s conference. If you are hearing or speech impaired, please contact the Agency by using the Florida Relay Service at (800) 955-8771 (TDD). It is the Agency’s intent to provide a formal response to each written question received by the Agency, when the Agency posts its formal response to questions; however in the interest of time, the Agency may group questions according to likeness and provide overall oral responses to like inquiries during the vendor’s conference. Due to space limitations, it is requested that prospective vendors send no more than two (2) representatives. For those prospective vendors that are not able to physically attend the vendor’s conference, the conference call dial-in number is (866) 338-0153. To participate in the call, dial the dial-in number. When prompted, enter conference code 70544100, followed by the # key.




10. Solicitation Addenda

If the Agency finds it necessary to supplement, modify, or interpret any portion of this ITN during the solicitation period, a written addendum will be posted on the VBS as addenda to this ITN. It is the prospective vendor’s responsibility to check VBS periodically for any information or updates to this ITN. The Agency bears no responsibility for any resulting impacts associated with a prospective vendor’s failure to obtain the information made available through the VBS.

11. Public Opening of Responses

Responses shall be opened on the date and at the location indicated in Section I.A.6, Solicitation Timeline. Respondents may, but are not required to, attend. The Agency will only announce the respondent(s) name at the public opening. Pursuant to Section 119.071(1)(b), Florida Statutes , no other materials will be released. Any person requiring a special accommodation because of a disability should contact the Issuing Officer at least five (5) workdays prior to the solicitation opening. If you are hearing or speech impaired, please contact the Agency by using the Florida Relay Service at (800) 955-8771 (TDD). To meet the requirements of Section 409.966(3)(a)(8), Florida Statutes, and as outlined in Section I.C.2, Provider Comments, the Agency will publish a list of respondents to this ITN within two (2) business days of the opening.

12. Type of Contract Contemplated

The Contract resulting from this ITN will be a fixed price (unit cost) Contract. The Vendor will be paid by the Agency’s Fiscal Agent pursuant to Attachment D Scope of Services - Core Provisions, Section IX, Method of Payment. The Agency intends that the Contract resulting from this ITN will be one of the following Contract types:

a. Capitated Managed Care Plan — A Managed Care Plan that is licensed or certified as a fully risk-bearing entity in the State, or qualified as a provider service network (PSN) pursuant to Section 409.912(4)(d), Florida Statutes , and is paid a prospective per-member-per-month (PMPM) capitation payment for MMA services as defined in Section V, Covered Services of Exhibit D-1, Managed Medical Assistance (MMA) Program, provided to eligible recipients defined in Attachment D, Scope of Services - Core Provisions, Section III, Eligibility and Enrollment and Exhibit D-1.

b. Fee-For-Service Provider Service Network — A Managed Care Plan qualified as a

PSN pursuant to Section 409.912(4)(d), Florida Statutes that is capitated for transportation only, with fee-for-service payments (FFS) for all other MMA services as defined in Section V, Covered Services of Exhibit D-1, Managed Medical Assistance (MMA) Program, provided to eligible recipients defined in Attachment D, Scope of Services - Core Provisions, Section III, Eligibility and Enrollment and Exhibit D-1. This Contract type uses a shared savings model with a monthly administrative payment.

Pursuant to Section 409.968(2), Florida Statutes, PSNs that choose not to be Capitated Managed Care Plans shall receive FFS rates with a shared savings settlement. The FFS



option shall be available to a PSN only for the first two (2) years of its operation. Any PSN operating under a Florida Medicaid Contract with the Agency as of September 1, 2012 must submit a response to this ITN as a Capitated Managed Care Plan. The Agency will only award a FFS PSN Contract if, as of September 1, 2012, the successful vendor was not contracted as a Medicaid PSN with the Agency. The Agency intends that the Contract resulting from this ITN will be one of the following plan types:

a. Standard MMA Plan – A Managed Care Plan providing MMA services as defined in Section V, Covered Services of Exhibit D-1, Managed Medical Assistance (MMA) Program, to eligible recipients defined in Attachment D, Scope of Services – Core Provisions, Section III, Eligibility and Enrollment and Exhibit D-1.

b. Specialty Plan – A Managed Care Plan providing MMA services as defined in

Section V, Covered Services of Exhibit D-1, Managed Medical Assistance (MMA) Program, to only eligible recipients defined in Attachment D, Scope of Services – Core Provisions, Section III, Eligibility and Enrollment and Exhibit D-1 who are defined as a specialty population in the resulting Contract.

Respondents must submit separate proposals for a Standard MMA Plan and Specialty Plans. The Agency will accept only one (1) proposal for a Standard MMA Plan per Region from each respondent. Respondents may submit multiple proposals for Specialty Plans for different specialty populations; however, the Agency will only award one (1) Specialty Plan Contract per Region to a successful vendor. If a vendor is awarded a Contract for a specialty population, the Agency reserves the right to issue one (1) Contract to include all awarded populations per vendor. If a vendor is awarded a Contract for multiple Regions, the Agency reserves the right to issue one (1) Contract to include all awarded Regions per vendor. Vendors that are awarded a Contract as an SMMC Standard MMA Plan for Region 1, and were previously awarded a Contract as an SMMC Long Term Care (LTC) Plan in Region 1, shall be considered to be a Comprehensive LTC Plan in Region 1. Upon becoming a Comprehensive LTC Plan, the Agency shall terminate the SMMC LTC Plan Contract and the vendor shall be required to sign a new Contract incorporating the requirements of both the SMMC LTC program and the SMMC MMA program. The Agency reserves the right to amend the resulting Contract within the scope set forth in this ITN (to include original Contract and all attachments) in order to clarify requirements or if it is determined by the Agency that modifications are necessary to better serve or provide covered services to the eligible population.

13. Term of Contract

Contract Execution is defined as the date the resulting Contract is signed by the Agency Secretary, or designee. Contract Term - The anticipated term of the resulting Contract is approximately five (5) years beginning January 1, 2014, and ending December 31, 2018. Vendor’s previously



awarded a LTC SMMC Contract who receive an MMA award will execute a Comprehensive LTC Contract, the term of which is approximately five (5) years beginning January 1, 2014, and ending December 31, 2018. Each September 1 through August 31 within the Contract term shall be defined as a Contract Year; however, the first Contract Year (Year 1) shall be defined as January 1, 2014 through August 31, 2014. Pursuant to Section 409.967(1), Florida Statutes, a Contract may not be renewed; however, the Agency may extend the resulting Contract(s) term to cover any delays during the transition to a new eligible vendor.

B. General Instructions for Response Preparation and Submission

1. Mandatory Requirements

The State has established certain requirements with respect to responses submitted to competitive solicitations. The use of “shall”, “must”, or “will” (except to indicate futurity) in this ITN, indicates a requirement or condition from which a material deviation may not be waived by the State. A deviation is material if, in the State’s sole discretion, the deficient response is not in substantial accord with the ITN requirements, provides an advantage to one respondent over another, or has a potentially significant effect on the quality of the response or on the cost to the State. Material deviations cannot be waived. The words “should” or “may” in this ITN indicate desirable attributes or conditions, but are permissive in nature. Deviation from, or omission of, such desirable feature will not in itself cause rejection of a response.

2. Independent Preparation of Response

A respondent shall not, directly or indirectly, collude, consult, communicate or agree with any other respondent as to any matter related to the response each is submitting. Additionally, a respondent shall not induce any other respondent to submit or not to submit a response.

3. Cost of Response Preparation

The costs related to the development and submission of a response to this ITN is the full responsibility of the respondent and is not chargeable to the Agency.

4. Proposal Guarantee For prospective vendors responding as a Standard MMA Plan, the original response must be accompanied by a proposal guarantee payable to the State of Florida in the amount of $948,360.00; the prospective vendor must be the guarantor. If responding as a joint venture/legal partnership, at least one party of the joint venture/legal partnership shall be the guarantor. For prospective vendors responding as a Specialty Plan, the original response must be accompanied by a proposal guarantee payable to the State of Florida in the amount of



$94,836.00; the prospective vendor must be the guarantor. If responding as a joint venture/legal partnership, at least one party of the joint venture/legal partnership shall be the guarantor. The proposal guarantee is a firm commitment such as a bid bond, certified check, or other negotiable instrument accompanying the proposal as assurance that the prospective vendor shall, upon the Agency’s acceptance of his or her proposal, execute such contractual documents as may be required within the time specified. The form of the proposal guarantee shall be a bond, cashier’s check, treasurer’s check, bank draft, or certified check. The Agency will not accept a letter of credit in lieu of the proposal guarantee. All proposal guarantees will be returned upon execution of the legal Contract with the successful vendor(s). If the successful vendor fails to execute a Contract within ten (10) consecutive calendar days after a Contract has been presented to the successful vendor for signature, the proposal guarantee shall be forfeited to the State. The proposal guarantee from the successful vendor will be returned only after the Agency has received the performance bond required under this ITN. FAILURE TO INCLUDE THE ORIGINAL PROPOSAL GUARANTEE WITH THE SUBMISSION OF THE ORIGINAL RESPONSE WILL RESULT IN THE REJECTION OF THE RESPONSE.

5. Joint Ventures and/or Legal Partnerships

Joint ventures or legal partnerships shall be viewed as one (1) respondent; however, each party to the joint venture/legal partnership shall submit all attachments and/or documentation required by this ITN from respondents, unless otherwise stated. FAILURE TO SUBMIT ALL REQUIRED ATTACHMENTS AND/OR DOCUMENTATION FROM ALL PARTIES INCLUDED IN A JOINT VENTURE OR LEGAL PARTNERSHIP, SIGNED BY AN AUTHORIZED OFFICIAL, IF APPLICABLE, WILL RESULT IN THE REJECTION OF THE RESPONSE.

6. Response Submission Requirements

Electronic submissions via MyFloridaMarketPlace are not required and will not be accepted for this ITN. This special instruction takes precedence over Attachment A, General Instructions to Respondents, #3, Electronic Submission of Responses.

The instructions for this ITN have been designed to help ensure that all responses are reviewed and evaluated in a consistent manner, as well as to minimize costs and response time. Information submitted in variance with these instructions may not be reviewed or evaluated.

Responses must be submitted in a sealed package (i.e., outer boxes must be sealed, individual binders within the box do not require individual sealing), to the Issuing Officer no later than the time indicated in Section I.A.6, Solicitation Timeline, for receipt of responses.



Respondents to this ITN shall submit the following: a. One (1) Original Response.

The original response shall be marked as the “original” and contain the transmittal letter that bears the original signature of the binding authority. The box that contains the “original” response shall be marked “Contains Original” and shall contain all marked originals (hard copy and electronic). Responses may be submitted via U.S. Mail, Courier, or hand delivery. Responses sent by fax or email will not be accepted. Responses received after the date and time specified in Section I.A.6, Solicitation Timeline, will not be considered and will be returned to the prospective vendor unopened.

b. Three (3) Duplicate Copies of the Original Response. c. One (1) Redacted Version of the Original Response.

Any portion of the submitted response which is asserted to be exempt from disclosure under Chapter 119, Florida Statutes, shall be set forth on a page or pages separate from the rest of the submission. Each page of the portion(s) asserted to be exempt shall be clearly marked “exempt”, “confidential”, or “trade secret” (as applicable) and shall also contain the statutory basis for such claim on every page. Pages containing trade secrets shall be marked “trade secret as defined in Section 812.081, Florida Statutes”. Failure to segregate and identify such portions shall constitute a waiver of any claimed exemption and the Agency will provide such records in response to public records requests without notifying the respondent. Designating material simply as “proprietary” will not necessarily protect it from disclosure under Chapter 119, Florida Statutes.

All information included in the response (including, without limitation, technical and cost information) and any resulting Contract that incorporates the successful response (fully, in part, or by reference) shall be a matter of public record regardless of copyright status. Submission of a response to this ITN shall constitute a waiver of any copyright protection which might otherwise apply to the production, disclosure, inspection and copying of such documentation.

The respondent shall also submit both a hard and an electronic redacted copy of the response suitable for release to the public in addition to the original and three (3) copies. Any confidential or trade secret information covered under Section 812.081, Florida Statutes, should be either redacted or completely removed. The redacted response shall be marked as the “redacted” copy.

RESPONDENTS MAY NOT MARK THEIR ENTIRE RESPONSE AS TRADE SECRET. ANY RESPONSE SO MARKED WILL BE REJECTED.

d. Five (5) electronic copies of the entire response, including one (1) marked

“Original” and one (1) marked “Redacted.”

The respondent shall submit five (5) electronic copies of the response, including one (1) marked “original” and one (1) marked “redacted.” The electronic format shall be submitted on CD-ROM. The software used to produce the electronic files must be



Microsoft Word 97 and/or Excel 97 or greater. Respondents may also submit documents in Adobe PDF, version 10. These electronic files must be logically named and easily mapped to the hard copy submittal. The electronic media must be clearly labeled in the same manner as the hard copies (e.g., original, copy, or redacted).

Response instructions for narrative and inclusion of attachments and/or documentation for the Technical Proposal and Cost Proposal are outlined in Attachment E, Technical Proposal Instructions and Attachment F, Cost Proposal Instructions respectively. Responses and attachments to the response shall be double sided and shall be typed in Arial 11 pt. font with 1 inch margins. Hard copy responses should be bound individually and submitted in three ring binders or secured in a similar fashion to contain pages that turn easily for review. Responses shall not exceed two (2) five (5) inch binders in length for the original response and attachments to the original response. All pages must be numbered, identify the ITN number, and include the respondent’s name.

All submittals received by the date and time specified in Section I.A.6, Solicitation Timeline, become the property of the State of Florida and shall be a matter of record subject to the provisions of Chapter 119, Florida Statutes. The State of Florida shall have the right to use all ideas, or adaptations of the ideas, contained in any reply received in response to this ITN. Selection or rejection of the response shall not affect this right.

7. Required Response Content

The ITN response shall consist of the following parts:

a. Transmittal Letter

The respondent shall submit a mandatory transmittal letter which serves as the document covering transmittal of the response package, as well as verification of prospective vendor name, address, and Federal Employer Identification (FEID) Number. The letter must provide the name, title, address, telephone number, original signature and email address of the official prospective vendor contact and an alternate, if available. These individuals shall have the authority to bind the prospective vendor to a Contract and shall be available to be contacted by telephone and to attend meetings as may be appropriate. The transmittal letter must state whether the response is for a Standard MMA Plan or a Specialty Plan. The transmittal letter must also authorize the Agency’s release of the redacted version of the response in the event the Agency receives a public records request.

If submitting a response as a joint venture or legal partnership, both parties must provide the requested information as described in this section.

FAILURE TO INCLUDE THE TRANSMITTAL LETTER WITH THE SUBMISSION OF THE ORIGINAL RESPONSE WILL RESULT IN THE REJECTION OF THE RESPONSE.



b. Proposal Guarantee

The respondent shall submit a proposal guarantee as specified in Section I.B.4. of this ITN. The proposal guarantee shall be included with the transmittal letter in the original response.

FAILURE TO INCLUDE THE ORIGINAL PROPOSAL GUARANTEE WITH THE SUBMISSION OF THE ORIGINAL RESPONSE WILL RESULT IN THE REJECTION OF THE RESPONSE.

c. Financial Information 1) Financial Statements – The respondent shall submit its most recent audited financial

statements for the past two (2) years and must respond to either a), b) or c) below.

a) If the respondent is a new entity, the respondent shall submit the most recent audit of its parent entity for the past two (2) years and an organizational chart showing the relationship between the respondent and parent entity. Parent entity is defined as the entity which will provide the primary financial support for the new entity. Audited financial statements must contain at a minimum:

1. The opinion of a certified public accountant (audits containing a disclaimer

opinion will not be accepted). 2. Balance Sheet(s) – Which are statement(s) of total assets, liabilities and net

worth at the end of the audit period(s). 3. Income Statement(s) or Revenue and Expense Statement(s) – Which are

statement(s) of profit or loss (for not-for-profits it is the excess of revenues over expenses) during the audit period(s).

4. Cash Flow Statement(s) – Which are statement(s) that reflect the inflow of revenue versus the outflow of expenses resulting from operating, investing, and financing activities during the audit period(s).

5. Notes to the financial statements which shall include: a description of the reporting entity, major asset categories, debt, contingency liabilities, transactions with related parties, subsequent events, and a list of significant accounting policies and estimates used.

OR

b) If the respondent is a new entity, without a previous or parent entity, the

respondent must submit independent certified audited financial statements for those individuals with five percent (5%) or more ownership interest in the respondent as documented through the respondent’s submission of a completed CMS-1513 Disclosure of Ownership and Control Interest Statement Form. All audited financial statements shall include:

1. The opinion of a certified public accountant; 2. A statement of revenue and expenses; 3. A balance sheet; 4. A statement of changes in financial position; and



5. A copy of all management letters.

OR c) If the respondent is an existing entity, the respondent shall submit its most recent

audited financial statements for the past two (2) years. 2) Pro Forma Financial Statements – The respondent must provide the following pro

forma financial statements for the applicant’s Florida operation, broken down by line of business. The pro forma financial statements must be prepared on an accrual basis by month for the first three (3) years beginning with the first month of the proposed execution date of the resulting Contract and include:

a) A statement of monthly revenue and expenses based on a recipient enrollment

rate of fifty percent (50%) of the required enrollment levels specified in Attachment C.1.D.4, Enrolment Levels of this ITN by the last month of the third year of operation;

b) A monthly cash flow analysis; and c) A balance sheet for each month.

3) Surplus Start-Up - The respondent shall describe and provide calculations used to

demonstrate how it will fund the Surplus Startup Account within thirty (30) calendar days after the Contract award is complete. The startup surplus must be in the form of cash or liquid assets excluding revenues from Medicaid payments. Lines of credit will not be considered as funding for this account. The audit of the respondent and/or parent will be evaluated to determine the respondent’s ability to fund the Surplus Startup Account. If funding for the Surplus Startup Account will come from a source other than the respondent or parent, the respondent must indicate the source and provide an audit, bank statement, and/or bank letter demonstrating the ability to fund this requirement. Surplus Startup Account is defined as the greater of three (3) months of operating expenses or $200,000 (Section 409.912(16), Florida Statutes). The respondent shall provide a calculation of three (3) months operating expense.

4) Surplus Account - The respondent shall describe and provide calculations used to demonstrate how it will fund the required surplus by the timeframe specified below for the particular Managed Care Plan Contract type (must respond to either a) or b) below).

a) Capitated Managed Care Plans: – The required surplus must be established

within thirty (30) calendar days after the Contract award is complete and must be in the form of cash, investments that mature within one hundred eighty (180) calendar days or less and allowable as admitted assets by the Office of Insurance Regulation (OIR), and restricted funds of deposits (AHCA insolvency account, OIR restricted deposits), the greater of $1.5 million, ten percent (10%) total liabilities, or two percent (2%) annualized premiums. (Section 409.912 and 641.225, Florida Statutes)

OR



b) Fee-For-Service PSNs: – The required surplus must be established by the twentieth (20th) month of operations (one hundred twenty (120) calendar days prior to capitation) and must be in the form of cash, investments that mature within one hundred eighty (180) calendar days or less and allowable as admitted assets by OIR, and restricted funds of deposits (AHCA insolvency account, OIR restricted deposits), the greater of $1.5 million, ten percent (10%) total liabilities, or two percent (2%) annualized premiums. (Section 409.912(16) and 641.225, Florida Statutes).

5) Insolvency Protection Account: - The respondent shall describe and provide

calculations used to demonstrate how it will fund the AHCA Insolvency Protection Account, as specified below by Managed Care Plan Contract type, within thirty (30) calendar days after the Contract award is complete. The audit of the respondent and/or parent will be evaluated to determine the respondent’s ability to fund the AHCA Insolvency Protection Account. If funding for the AHCA Insolvency Protection Account will come from a source other than the respondent or parent, the respondent must indicate the source and provide an audit, bank statement, and/or bank letter demonstrating the ability to fund this requirement (must respond to either a) or b) below).

a) Capitated Managed Care Plans: – AHCA Insolvency Protection Account is

defined as five percent (5%) of the estimated monthly capitation amount that would be paid to the Managed Care Plan by the Agency each month until a maximum total of two percent (2%) of the annualized total Contract amount. The respondent shall provide a calculation of the five percent (5%) estimate and indicate the anticipated source and method of funding this requirement.

OR

b) Fee-For-Service PSNs: – AHCA Insolvency Protection Account is defined as five

percent (5%) of the estimated administrative allocation payments that would be paid to the Managed Care Plan by the Agency each month until a maximum total of two percent (2%) of the annualized total Contract amount. The respondent shall provide a calculation of the five percent (5%) estimate and indicate the anticipated source and method of funding this requirement. In the twentieth (20th) month, the FFS Managed Care Plan must begin funding the insolvency protection account in accordance with requirements described in 5.a) above for Capitated Managed Care Plans.

The financial information Items 1-5 as requested above shall be labeled and tabbed separately. FAILURE TO SUBMIT FINANCIAL INFORMATION AS REQUIRED WILL RESULT IN REJECTION OF THE RESPONSE.

d. Past Performance - Client References (Must be provided on pages provided in Exhibit C-2.) The respondent shall submit a Past Performance – Client Reference Form. At a minimum, the respondent must list all names under which it has operated during the last



five (5) years in the space provided on Page 1 of Exhibit C-2. See Exhibit C-2, Past Performance – Client Reference Form for additional instructions for client reference submission. FAILURE TO SUBMIT AT LEAST PAGE 1 OF EXHIBIT C-2, PAST PERFORMANCE – CLIENT REFERENCE FORM, WILL RESULT IN THE REJECTION OF THE RESPONSE. RESPONDENTS WHO ARE ABLE TO SUBMIT CLIENT REFERENCE(S), FROM NON-AHCA CLIENTS, MUST SUBMIT CLIENT REFERENCES UTILIZING EXHIBIT C-2, PAST PERFORMANCE – CLIENT REFERENCE FORM. RESPONDENTS WHO ARE UNABLE TO SUBMIT CLIENT REFERENCES MUST CLEARLY INDICATE SO IN THE RESPONSE SUBMISSION AND WILL RECEIVE A SCORE OF ZERO (0) FOR THE PAST PERFORMANCE EVALUATION COMPONENT. EXHIBIT C-2, PAST PERFORMANCE – CLIENT REFERENCE FORM IS AVAILABLE FOR RESPONDENTS TO DOWNLOAD AT: HTTP://AHCA.MYFLORIDA.COM/PROCUREMENTS/INDEX.SHTML

e. Technical Response

The respondent shall submit a Technical Proposal as specified in Attachment E, Technical Proposal Instructions. Responses shall be submitted utilizing the Agency developed response submission tools, attached hereto in Attachment E. The required responses depend on the type of plan (Standard MMA Plan, Specialty Plan), as described below. The respondent shall include a Table of Contents in its Technical Proposal. The Table of Contents shall contain section headings and subheadings along with corresponding page numbers. The respondent shall include an Executive Summary in its Technical Proposal that demonstrates the respondent overall understands of the need for and purpose of the SMMC program and describes the salient features of the respondent’s technical response. For prospective vendors responding as a Standard MMA Plan, the respondent shall submit the responses utilizing Exhibit E-1, Standard Submission Requirements and Evaluation Criteria; Exhibit E-2, Standard Quality Measurement Tool; and Exhibit E-3, Provider Network File. For prospective vendors responding as a Specialty Plan, the respondent shall submit the responses utilizing Exhibit E-1, Standard Submission Requirements and Evaluation Criteria; Exhibit E-2, Standard Quality Measurement Tool; Exhibit E-3, Provider Network File; Exhibit E-4, Specialty Submission Requirements and Evaluation Criteria; and Exhibit E-5, Specialty Quality Measurement Tool. Exhibit E-1, Standard Submission Requirements and Evaluation Criteria; Exhibit E-2, Standard Quality Measurement Tool; Exhibit E-3, Provider Network File; Exhibit E-4, Specialty Submission Requirements and Evaluation Criteria; and Exhibit E-5, Specialty

http://ahca.myflorida.com/Procurements/index.shtml



Quality Measurement Tool; also referred to as the Technical Proposal, shall be labeled and tabbed separately. Additional instructions for completing the Technical Proposal are provided at Attachment E, Technical Proposal Instructions. RESPONSES WHICH DO NOT INCLUDE ATTACHMENT E, SUBMISSION REQUIREMENTS AND EVALUATION CRITERIA COMPONENTS, WILL BE REJECTED. ATTACHMENT E IS AVAILABLE FOR RESPONDENTS TO DOWNLOAD AT: HTTP://AHCA.MYFLORIDA.COM/PROCUREMENTS/INDEX.SHTML

f. Cost Proposal

The respondent shall submit a Cost Proposal as specified in Attachment F, Cost Proposal Instructions. Responses shall be submitted utilizing the Agency developed response submission templates, attached hereto in Attachment F. The required populations/elements required depend on the type of Contract being sought (capitated, non-capitated) and the type of plan (Standard MMA Plan, Specialty Plan), as described below. The Cost Proposal and Cost Proposal Rate Sheets, also referred to as the Cost Proposal, shall be labeled and tabbed separately. Additional instructions for completing the Cost Proposal and accompanying support are provided at Attachment F. 1) Capitated Managed Care Plans

Reimbursement structures that apply to HMOs and capitated PSNs are described in Attachment D, Scope of Services - Core Provisions, Section IX, Method of Payment. For most populations covered under this type of Contract, the Agency will use a cost proposal/negotiation process to establish rates for the first year. Exceptions to this process are: (1) LTC population members who are enrolled in a Comprehensive LTC Plan; (2) MMA enrollees who are also enrolled in their plan’s D-SNP product; (3) the Medically Needy population; and (4) Specialty Populations other than HIV/AIDS and Child Welfare. The table below summarizes the rate establishment process by population. Capitation rates established for all populations will comply with actuarial soundness requirements set forth in 42 CFR 438.6(c).

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK




MMA Eligible Population/Rate Applicable Plans Year 1

Rate Establishment

Process

TANF Standard MMA Plans; Comprehensive LTC Plans

Respondents submit cost proposal; subject to negotiation.

SSI No Medicare, non LTC eligible

Standard MMA Plans; Comprehensive LTC Plans

SSI with Medicare, non LTC eligible

Standard MMA Plans; Comprehensive LTC Plans

Dual Eligible, LTC eligible Standard MMA plans; Comprehensive LTC Plans

Medicaid Only, LTC eligible Standard MMA plans; Comprehensive LTC Plans

HIV/AIDS Specialty Population, with Medicare

Standard MMA Plans; Comprehensive LTC Plans; HIV/AIDs Specialty Plans

HIV/AIDS Specialty Population, No Medicare

Standard MMA Plans; Comprehensive LTC Plans; HIV/AIDs Specialty Plans

Child Welfare Specialty Population

Standard MMA Plans; Comprehensive LTC Plans; Child Welfare Specialty Plans

Transplant Kick Payments

Standard MMA Plans; Comprehensive LTC Plans; HIV/AIDS Specialty Plans, Child Welfare Specialty Plans, Other Specialty Plans

Established by AHCA.

LTC eligibles in a Comprehensive LTC plan

Comprehensive LTC Plans only

D-SNP enrollees Standard MMA Plans or Comprehensive LTC Plans that have a D-SNP product

Medically Needy Standard MMA Plans; Comprehensive LTC Plans

Other Specialty Population Other Specialty Plans

As noted above, certain reimbursement-related components will be established by the Agency, rather than subject to respondent bid and negotiation. Those components are described below. See Attachment D, Scope of Services - Core



Provisions, Section IX, Method of Payment for additional information about plan reimbursement.

a) Transplant kick payments will be established by the Agency for each year of the

Contract. These payments represent the results of negotiation between the Agency and transplant-providers. The applicable rates for the September 2014 – August 2015 period have not yet been established. For informational purposes only, the current rates are shown below:

CPT Code Transplant CPT Code Description

Children/Adolescents or Adult All Areas

32851 Lung single, without bypass

Children/Adolescents $320,800.00

32851 Lung single, without bypass

Adult $238,000.00

32852 Lung single, with bypass


32852 Lung single, with bypass

Adult $238,000.00

32853 Lung double, without bypass


32853 Lung double, without bypass

Adult $238,000.00

32854 Lung double, with bypass


32854 Lung double, with bypass

Adult $238,000.00

33945 Heart transplant with or without recipient cardiectomy

All Age Groups $162,000.00

47135 Liver, allotransplation, orthotopic, partial or whole from cadaver or living donor


47136 Liver, heterotopic, partial or whole from cadaver or living donor any age


b) MMA rates for LTC eligibles enrolled in a Comprehensive LTC Plan for both LTC and MMA services will be discounted to reflect the additional efficiencies available through the comprehensive plan delivery system. For the first year of operation (September 1, 2014 – August 31, 2015), a discount of ten percent (10%) will be applied to the negotiated MMA rates.



c) Rates for MMA enrollees who are also enrolled in the Managed Care Plan’s D-SNP

product will be established by the Agency in conjunction with the D-SNP 2014 and D-SNP 2015 Contract process.

d) Medically Needy monthly capitation rates will be established by the Agency once final terms and conditions for this program are received from CMS.

e) For prospective vendors responding as a Specialty plan other than an HIV/AIDS Specialty Plan or Child Welfare Specialty Plan, the Agency will establish capitation rates during the negotiation process based on identifiable target population(s) as proposed in Attachment E, Exhibit E-4, Specialty Submission Requirements and Evaluation Criteria. The Agency may incorporate established rates for any established Other Specialty Population(s) into Contracts with Standard MMA Plans and Comprehensive LTC Plans.

2) Fee-For-Service Provider Service Networks

Reimbursement structures that apply to non-capitated PSNs are described in Attachment D, Scope of Services - Core Provisions, Section IX, Method of Payment. This Contract type uses a shared savings model with a monthly administrative payment. A monthly capitation payment is made for transportation services. The table below summarizes the process to establish all Year 1 reimbursement components that will be used in the non-capitated PSN Contracts.

Reimbursement Component Year 1 Rate Establishment

Process

Shared savings benchmark Service cost component of the capitation rates AHCA negotiates with Capitated Plans

Administrative rates Bidders submit Cost Proposal; subject to negotiation with AHCA

Transportation monthly capitation rates Established by AHCA.

a) Shared savings benchmark PMPMs will be based on the services component of

the capitation rates that the Agency negotiates with Capitated Managed Care Plans. These values will be provided to non-capitated PSNs at the completion of the negotiation process.

b) Transportation capitation rates will be established by the Agency for each year of the Contract. The applicable rates for Year 1 have not yet been established.

The respondent’s Cost Proposal must include all required rates/support for all required Eligibility Groups based on the type of Contract/plan being bid, as shown in the tables above, or THE RESPONSE WILL BE REJECTED. FAILURE TO SUBMIT ATTACHMENT F, COST PROPOSAL, EXHIBIT F-10, CAPITATED PLAN COST PROPOSAL OR EXHIBIT F-11, NON-CAPITATED



COST PROPOSAL, AND SUPPORTING DOCUMENTATION, WILL RESULT IN THE REJECTION OF THE RESPONSE.

ATTACHMENT F, EXHIBIT F-10, CAPITATED PLAN COST PROPOSAL AND EXHIBIT F-11, NON-CAPITATED COST PROPOSAL, IS AVAILABLE FOR RESPONDENTS TO DOWNLOAD AT: HTTP://AHCA.MYFLORIDA.COM/PROCUREMENTS/INDEX.SHTML

8. Required Certifications and Statements

Respondents to the ITN shall submit Exhibit C-3, Required Certifications and Statements.

FAILURE TO SUBMIT EXHIBIT C-3, REQUIRED CERTIFICATIONS AND STATEMENTS, SIGNED BY AN AUTHORIZED OFFICIAL WILL RESULT IN THE REJECTION OF A PROSPECTIVE VENDOR’S RESPONSE. THE AGENCY WILL NOT ACCEPT ANY ALTERATION(S), DEVIATION(S) AND/OR CAVEAT(S) TO THE CERTIFICATIONS REQUIRED BY EXHIBIT C-3. SUBMISSIONS WHICH ALTER, DEVIATE AND/OR CAVEAT THE CERTFICIATION REQUIREMENTS OF EXHIBIT C-3 WILL RESULT IN THE REJECTION OF THE RESPONSE. EXHIBIT C-3, REQUIRED CERTIFICATIONS AND STATEMENTS, IS AVAILABLE FOR RESPONDENTS TO DOWNLOAD AT: HTTP://AHCA.MYFLORIDA.COM/PROCUREMENTS/INDEX.SHTML

9. Other Required Documentation Respondents to this ITN shall submit Exhibit C-4, Disclosure of Ownership and Control Interest Statement (CMS 1513) with its response. PSNs shall also submit Exhibit C-5, Managed Medical Assistance (MMA) Provider Service Network (PSN) Provider Ownership Interest Disclosure Report.

The respondent shall complete Exhibit C-6, List of Terminated Contracts, listing all terminated Contracts in chronological order and provide a brief description (half-page or less) of the reason(s) for the termination. The Agency reserves the right within its sole discretion, to determine the respondent to be an irresponsible bidder based on any or all of the listed Contracts and therefore may reject the vendor’s response.

The respondent shall complete Exhibit C-7, Vendor Certification Regarding Scrutinized Companies Lists, certifying that it is not listed on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, created pursuant to Section 215.473, Florida Statutes. Pursuant to Section 287.135(5), Florida Statutes, the respondent agrees the Agency may immediately terminate the resulting Contract for cause if the respondent is found to have submitted a false certification or if the respondent is placed on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List during the term of the resulting Contract. Pursuant to Section 409.975(1)(d), Florida Statutes, each Managed Care Plan must offer a network Contract to each home medical equipment and supplies provider in the Region which meets quality and fraud prevention and detection standards established by the plan





and which agrees to accept the lowest price previously negotiated between the plan and another such provider. For the respondent’s convenience, all home medical equipment and supplies providers located in Region 1 are specified in Exhibit C-8, Home Medical Equipment and Supplies Providers List.

FAILURE TO SUBMIT EXHIBITS C-4 THROUGH C-7, SIGNED BY AN AUTHORIZED OFFICIAL, WILL RESULT IN THE REJECTION OF A PROSPECTIVE VENDOR’S RESPONSE. THE AGENCY WILL NOT ACCEPT ANY ALTERATION(S), DEVIATION(S) AND/OR CAVEAT(S) TO ANY EXHIBIT. SUBMISSIONS WHICH ALTER, DEVIATE AND/OR CAVEAT THE STATEMENTS CONTAINED IN ANY EXHIBIT WILL RESULT IN THE REJECTION OF THE RESPONSE. EXHIBITS C-4, THROUGH C-7, ARE AVAILABLE FOR RESPONDENTS TO DOWNLOAD AT: HTTP://AHCA.MYFLORIDA.COM/PROCUREMENTS/INDEX.SHTML

10. Conflict of Interest Mitigation Plan The standards on organizational conflicts of interest in Chapter 48, Code of Federal Regulations and Section 287.057(17), Florida Statutes, apply to this ITN. A prospective vendor with an actual or potential organizational conflict of interest shall disclose the conflict. If the prospective vendor believes the conflict of interest can be mitigated, neutralized or avoided, the prospective vendor shall include with its submission a Conflict of Interest Mitigation Plan. The plan shall, at a minimum:

• Identify any relationship, financial interest or other activity which may create an actual or

potential organizational conflict of interest. • Describe the actions the prospective vendor intends to take to mitigate, neutralize, or

avoid the identified organizational conflicts of interest. • Identify the official within the prospective vendor’s organization responsible for making

conflict of interest determinations.

The Conflict of Interest Mitigation Plan will be evaluated as acceptable or not acceptable and will be used to determine vendor responsibility, as defined in Section 287.012(24), Florida Statutes. The Agency reserves the right to request additional information from the prospective vendor or other sources, as deemed necessary, to determine whether or not the plan adequately neutralizes, mitigates, or avoids the identified conflicts.

C. Response Evaluation, Negotiations and Contract Awards

1. Response Clarification

The Agency reserves the right to seek written clarification from a prospective vendor of any information contained in the prospective vendor’s response.




2. Provider Comments:

Pursuant to Section 409.966(3)(a)8, Florida Statutes the Agency shall consider comments in writing by any enrolled Medicaid Provider relating to a specifically identified prospective vendor participating in this ITN, and is in the same Region as the submitting Provider. The Agency shall publish a list of respondents to this ITN within two (2) business days of the opening to the SMMC website: http://ahca.myflorida.com/medicaid/statewide_mc/index.shtml and the instructions for the providers to submit comments. Only enrolled Medicaid providers in the same Region indicated in this ITN may submit comments related to prospective vendors that are participating in this ITN. Comments shall be submitted to the Agency, in writing, by the Date/Time indicated in Section I.A.6, Solicitation Timeline and as outlined on the SMMC website. The Agency will utilize an online survey tool for the collection of the provider comments.

Below is an example of the process and the survey tool that will be utilized: Step 1: On the SMMC website the provider will select the Region it is commenting on by clicking on link which will lead the user to each regional survey.

Example: REGION 1 – Escambia, Okaloosa, Santa Rosa and Walton Counties (HYPERLINK)

Step 2: Complete Survey. The provider will type in its name, its Medicaid provider number and assign opinions for each prospective vendor listed in the Region. SAMPLE: REGION 1 – Escambia, Okaloosa, Santa Rosa and Walton Counties

Instructions: For each prospective vendor listed below, the provider shall indicate if its opinion of the named prospective vendor is positive, negative or neutral. The election of the opinions listed below will be considered by the Agency in its decision to award Contracts under the Managed Medical Assistance ITN, pursuant to Section 409,966(3)(a)8, Florida Statutes. Scores will be calculated based on the election of “Positive”, “Negative” or “Neutral” as outlined in Attachment C, Special Conditions and Instructions, Section I.C.3.c, Review of Provider Comments, of the ITN. Vendor A: ☐ Positive ☐ Negative ☐ Neutral

Enter Medicaid Provider Name – Character Space Limitation of 300 characters

Enter [Medicaid Provider Number – Character Space Limitation of 20 characters

http://ahca.myflorida.com/medicaid/statewide_mc/index.shtml



Vendor B: ☐ Positive ☐ Negative ☐ Neutral PROVIDER COMMENTS SHALL NOT BE SUBMITTED WITH THE PROSPECTIVE VENDOR’S RESPONSE. ANY PROVIDER COMMENT SUBMITTED WITH A PROSPECTIVE VENDOR’S RESPONSE WILL NOT BE CONSIDERED.




3. Evaluation Criteria

a. Review of Mandatory Criteria

The Procurement Office and other Agency staff will evaluate responses to this ITN against the mandatory criteria found in the table below. These evaluation questions will be used by the Agency to designate responses as “responsive” or “non-responsive”. If the answer to any of the questions in the table below falls into the “No” column, the response will be designated as “nonresponsive” and will not be considered for further evaluation.

MANDATORY CRITERIA QUESTIONS YES NO

A. Does the response include a Transmittal Letter, signed by an individual having authority to bind the respondent, as specified in Attachment C, Special Conditions and Instructions, Section I.B.7.a. of this ITN?

B. Does the response include an original Proposal Guarantee as required in Attachment C, Special Conditions and Instructions, Section I.B.7.b. of this ITN, in an amount as specified in Attachment C, Special Conditions and Instructions, Section I.B.4 of this ITN?

C. Does the response include Financial Information as required Attachment C, Special Conditions and Instructions, Section I.B.7.c. of this ITN?

D. Does the response include Exhibit C-2, Past Performance – Client Reference Form, as required in Attachment C, Special Conditions and Instructions, Section I.B.7.d. of this ITN?

E. Does the response include a Technical Response and Exhibits, as required in Attachment C, Special Conditions and Instructions, Section I.B.7.e. and Attachment E of this ITN?

F. Does the response include a Cost Proposal and Exhibits, as required in Attachment C, Special Conditions and Instructions, Section I.B.7.f. and Attachment F of this ITN?

G. Does the response include a signed Exhibit C-3, Required Certifications and Statements, as specified in Attachment C, Special Conditions and Instructions, Section I.B.8. of this ITN?

H. Does the response include a signed Exhibit C-4, Disclosure of Ownership and Control Interest Statement (CMS 1513), as specified in Attachment C, Special Conditions and Instructions, Section I.B.9. of this ITN?

I. Does the response include a signed Exhibit C-5, Managed Medical Assistance (MMA) Provider Service Network (PSN) Provider Ownership Interest Disclosure Report, if applicable, as specified in Attachment C, Special Conditions and Instructions, Section I.B.9. of this ITN?

J. Does the response include a signed Exhibit C-6, List of Terminated Contracts, as specified in Attachment C, Special Conditions and Instructions, Section I.B.9. of this ITN?

K. Does the response include a signed Exhibit C-7, Vendor Certification Regarding Scrutinized Companies Lists, as required in Attachment C, Special Conditions and Instructions, Section I.B.9. of this ITN?



b. Financial Stability Evaluation

A Certified Public Accountant will evaluate each respondent’s financial information. A maximum total score of twenty (20) will be based on analysis of three (3) parts of the financial section (Stability, Projections, and Required Accounts) as follows:

Part Financial Section Issue Scale Points Factor

Part A Stability Rate the Financial Stability of the Respondent

Excellent 20

50% Above Average 15 Average 10 Below Average 5 Weak/Poor 0

Part B Projections Are the Projections Reasonable?

Yes 20 25%

No 0

Part C

Required Accounts

What is the likelihood that the accounts will be funded (Start-Up)?

Likely 20 3% Questionable 10

Unlikely 0

Part D

What is the likelihood that the accounts will be funded (Surplus)?


Unlikely 0

Part E What is the likelihood that the accounts will be funded (Insolvency)?


Unlikely 0 Respondents determined to have insufficient financial resources to fully perform the Contract requirements outlined in this ITN will be disqualified at the Agency’s sole discretion.

Scoring Formula: Part Points X Factor

Scoring Example

Part

Maximum Allowable

Points

Maximum Calculated

Total Points

Sample Points Scored

Sample Calculated

Scored Points

Part A 20 10 15 7.50 Part B 20 5 20 5 Part C 20 .60 10 .30 Part D 20 3 0 .00 Part E 20 1.40 10 .70 Maximum

Total Score

20

Sample Total Score

13.50



c. Review of Provider Comments

The Agency will evaluate Provider Comments received using the following scoring method:

A. Number of POSITIVE comments B. Number of NEGATIVE comments C. Total Number of comments D. Subtract (B) from (A) [38 – 3] E. Divide (D) by (C) [35/47] F. Multiply (E) by WEIGHT .745 *[47/60 * 2.5] G. Add (F) to 2.5 for FINAL score [Round to one decimal]

In this example, the Respondent will receive a positive 4.0 score.

d. Past Performance Evaluation

Past performance will be scored based on answers to the questions outlined in Exhibit C-2, Past Performance – Client Reference Form received from a maximum of three (3) separate client references.

e. Technical Response Evaluation

Each response determined to be in compliance with all mandatory criteria will be independently evaluated based on the criteria and points scale indicated below. Each response will be scored by at least three (3) evaluators, who collectively have experience and knowledge in the program areas and service requirements for which contractual services are sought by this ITN. The Agency reserves the right to have specific sections of the responses evaluated by less than three (3) individuals. Detailed evaluation criteria components will be evaluated and awarded points based on the following point structure, unless otherwise identified in Attachment E, Technical Proposal Instructions; Exhibit E-1, Standard Submission Requirements and Evaluation Criteria; Exhibit E-2, Standard Quality Measurement Tool; Exhibit E-3, Provider Network File; Exhibit E-4, Specialty Submission Requirements and Evaluation Criteria; and Exhibit E-5, Specialty Quality Measurement Tool:

Points

0 The component was not addressed. 1 The component contained significant deficiencies. 2 The component is below average. 3 The component is average. 4 The component is above average. 5 The component is excellent.

Submission Requirements and Evaluation Criteria Components (SRCs) outlined in Attachment E, Technical Proposal Instructions, Exhibit E-1, Standard Submission Requirements and Evaluation Criteria, and Exhibit E-4, Specialty Submission

38 3

47 35

4.0

0.745 1.45



Requirements and Evaluation Criteria, marked as “Core” must be identical for each Region in which the respondent submitted a proposal. Attachment E, Technical Proposal Instructions, Exhibit E-2, Standard Quality Measurement Tool, and Exhibit E-5, Specialty Quality Measurement Tool, must be identical for each Region in which the respondent submitted a proposal. For timeliness of response evaluation, the Agency will evaluate each “Core” SRC and quality measurement tools once and will transfer the score to each applicable Region’s evaluation score sheet(s). A SRC marked as “Regional” will be specific and only apply to the Region identified in the ITN and the evaluation score will not be transferred to each Region’s score sheet(s). Attachment E, Technical Proposal Instructions, Exhibit E-3, Provider Network File, will also be specific and only apply to the Region identified in the ITN and the evaluation score will not be transferred to each Region’s score sheet(s). The scores of independent evaluators will be computed for each Region’s score sheet(s) to determine a total score based on the detailed evaluation criteria components indicated in Attachment E, Technical Proposal Instructions and the weight factor specified below:

Respondents bidding as a Standard MMA Plan have a total available raw score of 1195 points, with a total maximum points available of 1326.25. Respondents bidding as a Standard MMA Plan will be ranked based on the total maximum available points of 1326.25.

Respondents bidding as a Specialty Plan have a total available raw score of 1335 points (1195 points for the standard components of their response and 140 additional points available for the specialty components of their response), with a total maximum points available of 1477.5 (1326.25 points for the standard components of their response and 151.25 additional points available for the specialty components of their response). Respondents bidding as a Specialty Plan will be ranked based on the total maximum available points of 1477.5.




Standard MMA Plan Specialty Plan

Maximum Raw

Score Possible

Weight Factor

Maximum Points

Available

Maximum Additional

Raw Score

Possible

Weight Factor

Maximum Additional

Points Available

Total Available

Points

A. Mandatory Documentation - - - - - - Pass/Fail

B. Financial

Information 20 7 140 0 - 0 140

C. Past Performance 1. Client #1 25 0.5 12.5 0 - 0 12.5 2. Client #2 25 0.5 12.5 0 - 0 12.5 3. Client #3 25 0.5 12.5 0 - 0 12.5 4. Provider

Comments 5 2 10 0 - 0 10

D. Technical Response

1. Table of Contents - - - - - - Not

Scored

2. Executive Summary - - - - - -

Not Scored

3. Qualifications and Experience 175 1.5 262.5 20 1.5 30 292.5

4. Eligibility and Enrollment 40 1 40 40 1 40 80

5. Enrollee Services and Grievance 95 1 95 0 - 0 95

6. Covered Services 185 0.75 138.75 35 0.75 26.25 165

7. Provider Network 175 1 175 25 1 25 200

8. Quality and Utilization Management

145 1.5 217.5 20 1.5 30 247.5

9. Administration and Management 280 0.75 210 0 - 0 210

TOTAL 1195 1326.25 140 151.25 1477.5



f. Cost Proposal

The Agency will review and consider the cost proposals submitted by respondents who are invited to negotiations during the negotiation phase as described in Section I. C. 4, Negotiation Process of this ITN.

g. Ranking of Responses

A total score will be calculated for each response. The total point scores will be used to rank the responses by evaluator (response with the highest number of points = 1, second highest = 2, etc.). An average rank for each response will be calculated for all evaluators.

Scoring Example: In this example, there are 461 maximum available points and four (4) respondents. Step 1 - A total score will be calculated for each response.

Evaluator A Evaluator B Evaluator C Evaluator D Respondent 1 451 pts. Respondent 1 401 pts. Respondent 1 316 pts. Respondent 1 418 pts. Respondent 2 425 pts. Respondent 2 390 pts. Respondent 2 443 pts. Respondent 2 449 pts. Respondent 3 397 pts. Respondent 3 419 pts. Respondent 3 389 pts. Respondent 3 435 pts. Respondent 4 410 pts. Respondent 4 388 pts. Respondent 4 459 pts. Respondent 4 325 pts.

Step 2 - The total point scores will be used to rank the responses by evaluator (response with the highest number of points = 1, second highest = 2, etc.).

Step 3 - An average rank will be calculated for each response for all the evaluators.

4. Negotiation Process

The Agency will invite to negotiation the top ranking minimum number of Standard MMA Plans per Region, as outlined in the MMA Plans Per Region table below and in Section 409.974, Florida Statutes, plus two (2) additional plans for each Region.

Evaluator A Evaluator B Evaluator C Evaluator D Respondent 1 1 Respondent 1 2 Respondent 1 4 Respondent 1 3 Respondent 2 2 Respondent 2 3 Respondent 2 2 Respondent 2 1 Respondent 3 4 Respondent 3 1 Respondent 3 3 Respondent 3 2 Respondent 4 3 Respondent 4 4 Respondent 4 1 Respondent 4 4

Respondent 1 1+2+4+3=10÷4=2.5 Respondent 2 2+3+2+1=8÷4=2.0 Respondent 3 4+1+3+2=10÷4=2.5 Respondent 4 3+4+1+4=12÷4=3.0



In addition to the number of Standard MMA Plans invited to negotiations, as outlined in the MMA Plans Per Region Table, the Agency will invite to negotiation the top two (2) ranking Specialty Plans per specialty population that submit a responsive bid. If at least two (2) PSNs are not included in the Standard MMA Plans to be invited to negotiation, the next top ranking PSN(s) submitting a responsive reply in the Region will also be included to ensure that at least two (2) PSNs are brought forward to negotiation. While the first round of negotiations is taking place, the Agency will review the invited respondents’ cost proposals and associated back-up for reasonableness and cost-effectiveness. Proposed capitation rates will be compared to guidelines from the Agency’s actuaries as to actuarially sound levels developed after review of prospective vendors’ cost proposals. Proposed rates that fall outside those guidelines will be reviewed by the Agency’s actuaries for reasonableness. For prospective vendors responding as FFS PSNs, proposed administrative rates will be reviewed as described above for proposed capitation rates. At the conclusion of the first round of negotiations, respondents providing the best value to the State through low rates and acceptable technical response requirements, as evaluated may be invited to participate in a second round of negotiations. Rates relating to the following will not be negotiated: (1) the Medically Needy population; (2) MMA enrollees who are also enrolled in their Managed Care Plan’s D-SNP product; (3) LTC population members who are enrolled in a Comprehensive LTC Plan; (4) Shared Savings Benchmark for FFS PSNs; (5) Transportation Capitation rate for FFS PSNs; and (6) Transplant Kick Payments. The table below illustrates the minimum number of plans to be selected for negotiation for Region 1 without any extra slots reflected for PSNs and/or Specialty Plans.

MMA Plans Per Region

Statutory Min/ Max

Plans

Minimum # For

Negotiation

# For Contract

Region 1 2 4 2

In the event the Agency cannot reach agreement with a Standard MMA Plan who has been invited to negotiation and/or a Standard MMA Plan withdraws their response during the negotiation phase, the Agency reserves the right to invite the next top ranking Standard MMA Plan(s) remaining in order of their ranking, as needed, to ensure the Agency can enter into Contract with the required number of Standard MMA Plans per Region as illustrated in the MMA Plans Per Region table above.

5. Number of Awards:

In accordance with Section 409.974, Florida Statutes, the Agency anticipates the issuance of two (2) Contracts for Standard MMA Plans as a result of this ITN. The successful vendor(s) for each Contract shall be required to provide services as identified in this ITN to all eligible Medicaid recipients in Region 1 as described in this solicitation. At least one (1) award in this Region will be to a PSN provided a PSN submits a responsive reply and



negotiates a rate acceptable to the Agency. The Agency, at its sole discretion, shall make this determination. In addition to the number of Contracts for Standard MMA Plans awarded in this Region, additional Contracts shall be awarded to Specialty Plans that submit a responsive bid and negotiate a rate acceptable to the Agency. The Agency, at its sole discretion, shall make this determination.

The Agency shall award one (1) additional Region to each Vendor who receives a Region 1 Contract award. The Vendor shall submit its regional preference for the additional award through submission of a completed Exhibit C-9, Region 1 Regional Preference Hierarchy. The Agency shall award the additional Contract in the Vendor’s highest desired Region of preference in which the Vendor submitted a responsive reply and negotiates a rate acceptable to the Agency. If the Vendor has already been chosen through the negotiation process in its top regional choice as listed in Exhibit C-9, Region 1 Regional Preference Hierarchy then it will be awarded its next Exhibit C-9 regional choice provided it meets the terms above. If a vendor is awarded a Contract to participate as a Specialty Plan in Region 1, the Agency shall award an additional Contract for the vendor to participate as that same Specialty Plan for the same Specialty Population in another Region in which the plan has submitted a responsive bid, and negotiates a rate acceptable to the Agency. The vendor shall comply with the above terms regarding submitting its Regional Preference Hierarchy in Exhibit C-9, Region 1 Regional Preference Hierarchy. If a vendor is awarded a Contract for multiple Regions/populations, the Agency reserves the right to issue one (1) Contract to include all awarded Regions and populations per vendor. EXHIBIT C-9, REGION 1 REGIONAL PREFERENCE HIERARCHY IS AVAILABLE FOR RESPONDENTS TO DOWNLOAD AT HTTP://AHCA.MYFLORIDA.COM/PROCUREMENTS/INDEX.SHTML.

6. Posting of Notice of Intent to Award:

Tabulation of Results, with the recommended Contract award, will be posted and will be available for review by interested parties at the time and location specified in Section I.A.6, Solicitation Timeline, and will remain posted for a period of seventy-two (72) hours, not including weekends or State observed holidays. Any responding prospective vendor desiring to protest the recommended Contract award must file a notice of protest to the Issuing Officer identified in Section I.A.5, and any formal protest with the Agency for Health Care Administration, Agency Clerk, 2727 Mahan Drive, MS #3, Building 3, Room 3407C, Tallahassee, Florida 32308, within the time prescribed in Section 120.57(3) Florida Statutes, and Chapter 28-110, Florida Administrative Code. Failure to file a protest within the time prescribed in Section 120.57(3), Florida Statutes, shall constitute a waiver of proceedings under Chapter 120, Florida Statutes. Pursuant to Section 409.966(4), Florida Statues, any eligible plan that participates in an invitation to negotiate in more than one Region and is selected in at least one Region may not begin serving Medicaid recipients in any Region for which it was selected until all administrative challenges to procurements required by this section to which the eligible plan is a party have been finalized. If the number of plans selected is less than the maximum



amount of plans permitted in the Region, the Agency may contract with other selected plans in the Region not participating in the administrative challenge before resolution of the administrative challenge. For purposes of this subsection, an administrative challenge is finalized if an order granting voluntary dismissal with prejudice has been entered by any court established under Article V of the State Constitution or by the Division of Administrative Hearings, a final order has been entered into by the Agency and the deadline for appeal has expired, a final order has been entered by the First District Court of Appeal and the time to seek any available review by the Florida Supreme Court has expired, or a final order has been entered by the Florida Supreme Court and a warrant has been issued.

7. Performance Bond A performance bond in the amount of $5,000,000 shall be furnished to the Agency for each Region in which the vendor is awarded a Contract. If the vendor is awarded a Contract in more than one (1) Region, the vendor shall furnish a single bond for the total amount (e.g., if the vendor is awarded a Contract in two (2) Regions, the vendor shall submit one (1) bond for $10,000,000). Vendors that are awarded a SMMC MMA Contract, and were previously awarded a SMMC LTC Contract, shall cancel their SMMC LTC Performance Bond and secure a new bond in accordance with the above provisions. The bond will be furnished to the Issuing Officer identified in Section I.A.5 within thirty (30) calendar days after execution of the resulting Contract and prior to commencement of any work under the Contract.

For vendors awarded a Contract as a Specialty Plan, a performance bond in the amount of $1,000,000 shall be furnished to the Agency for each Region in which the vendor is awarded a Contract. If the vendor is awarded a Contract in more than one (1) Region, the vendor shall furnish a single bond for the total amount (e.g., if the vendor is awarded a Contract in two (2) Regions, the vendor shall submit one (1) bond for $2,000,000). The bond will be furnished to the Issuing Officer identified in Section I.A.5 within thirty (30) calendar days after execution of the resulting Contract and prior to commencement of any work under the Contract. No payments will be made to the successful vendor until the performance bond is in place and approved by the Agency in writing. The performance bond shall remain in effect for the full term of the resulting Contract, including any extension. The Agency shall be named as the beneficiary of the successful vendor’s bond. The bond shall provide that the insurer or bonding company(s) shall pay losses suffered by the Agency due to termination directly to the Agency.

The cost of the performance bond will be borne by the successful vendor. Should the successful vendor terminate the resulting Contract prior to the end of the Contract period or be terminated by the Agency (with cause), an assessment against the bond will be made by the Agency to cover the costs of issuing a new solicitation and selecting a new vendor. The vendor agrees that the Agency’s damages in the event of termination by the vendor or the Agency shall be considered to be for the full amount of the bond allocated to the Region for which the Contract was terminated. The Agency need not prove the damage amount in exercising its right of recourse against the bond.



8. Fidelity Bond

The vendor shall secure and maintain during the life of the resulting Contract and any Contract extension(s), a blanket fidelity bond from a company doing business in the State of Florida on all personnel in its employment. The bond shall be issued in the amount of at least $250,000 per occurrence. Said bond shall protect the Agency from any losses sustained through any fraudulent or dishonest act or acts committed by any employees of the vendor and subcontractors, if any. Proof of coverage shall be submitted to the Issuing Officer identified in Section I.A.5 within sixty (60) calendar days after execution of the Contract and prior to the delivery of health care. To be acceptable to the Agency for fidelity bonds, a surety company shall comply with the provisions of Chapter 624, Florida Statutes.

9. Lobbying Disclosure

The successful vendor shall comply with applicable federal requirements for the disclosure of information regarding lobbying activities of the successful vendor, subcontractors or any authorized agent. Certification forms shall be filed by the successful vendor and all subcontractors, certifying that no federal funds have been or shall be used in federal lobbying activities, and the disclosure forms shall be used by the successful vendor and all subcontractors to disclose lobbying activities in connection with the Medicaid program that have been or shall be paid with non-federal funds.

The successful vendor shall comply with the provisions of Section 216.347, Florida Statutes, which prohibits the expenditure of Contract funds for the purpose of lobbying the Legislature or a state agency.

10. Insurance

To the extent required by law, the successful vendor will be self-insured against, or will secure and maintain during the life of the resulting Contract, Worker’s Compensation Insurance for all its employees connected with the work of this project and, in case any work is subcontracted, the successful vendor shall require the subcontractor similarly to provide Worker’s Compensation Insurance for all of the latter’s employees unless such employees engaged in work under the resulting Contract are covered by the successful vendor’s self insurance program. Such self insurance or insurance coverage shall comply with the Florida Worker’s Compensation law. In the event hazardous work is being performed by the successful vendor under the resulting Contract and any class of employees performing the hazardous work is not protected under Worker’s Compensation statutes, the successful vendor shall provide, and cause each subcontractor to provide, adequate insurance satisfactory to the Agency, for the protection of his employees not otherwise protected.

The successful vendor shall secure and maintain Commercial General Liability insurance including bodily injury, property damage, personal and advertising injury and products and completed operations. This insurance will provide coverage for all claims that may arise from the services and/or operations completed under the resulting Contract, whether such services and/or operations are by the successful vendor or anyone directly, or indirectly employed by him. Such insurance shall include the State of Florida as an Additional Named Insured for the entire length of the resulting Contract and hold the State of Florida harmless from subrogation. The successful vendor is responsible for determining the minimum limits



of liability necessary to provide reasonable financial protections to the successful vendor and the State of Florida under the resulting Contract.

All insurance policies shall be with insurers licensed or eligible to transact business in the State of Florida. The successful vendor’s current certificate of insurance policy(ies) shall contain a provision that the insurance will not be canceled for any reason except after thirty (30) days written notice. The successful vendor shall provide thirty (30) day written notice of cancellation to the Agency’s Contract Manager.

The successful vendor shall submit insurance certificates evidencing such insurance coverage prior to execution of a Contract with the Agency.

11. State Project Plan

Within thirty (30) calendar days following award of the resulting Contract, the successful vendor shall submit a plan addressing each of the five (5) objectives listed below, to the extent applicable to the services covered by this ITN. The State reserves the right to direct changes and/or modifications in regard to the below objectives with the respondent selected for award, prior to execution of the resulting Contract.

a. Vendor Diversity: The State supports and encourages supplier diversity and the

participation of small and minority business enterprises in state contracting, both as prime contractors and subcontractors. The respondent shall submit as part of this plan, its approach to supporting the State’s vendor diversity program, and the intent of Section 287.09451, Florida Statutes.

Additional assistance may be obtained by contacting the Office of Supplier Diversity at (850) 487-0915 or online at http://osd.dms.state.fl.us/.

b. Environmental Considerations: The State supports and encourages initiatives to

protect and preserve our environment. The respondent shall submit as part of this plan, the respondent’s plan to support the procurement of products and materials with recycled content, and the intent of Section 287.045, Florida Statutes. The respondent shall also provide a plan for reducing and/or handling of any hazardous waste generated by the respondent company. Reference Rule 62-730.160, Florida Administrative Code. It is a requirement of the Florida Department of Environmental Protection that a generator of hazardous waste materials that exceeds a certain threshold must have a valid and current Hazardous Waste Generator Identification Number. This identification number shall be submitted as part of the respondent’s explanation of its company’s hazardous waste plan and shall explain in detail its handling and disposal of waste.

c. Certification of Drug-Free Workplace Program: The State supports and encourages

initiatives to keep the workplace of Florida’s suppliers and contractors drug free. Section 287.087 Florida Statutes provides that, where identical tie proposals are received, preference shall be given to a proposal received from a respondent that certifies it has implemented a drug-free workplace program. If applicable, the respondent shall sign and submit the “Certification of Drug-Free Workplace Program” Form, attached hereto and made a part hereof as Exhibit C-10, to certify that the respondent has a drug-free workplace program.

http://osd.dms.state.fl.us/



EXHIBIT C-10, CERTIFICATION OF DRUG-FREE WORKPLACE PROGRAM, IS AVAILABLE FOR RESPONDENTS TO DOWNLOAD AT: HTTP://AHCA.MYFLORIDA.COM/PROCUREMENTS/INDEX.SHTML.

d. Products Available from the Blind or Other Handicapped (RESPECT): The State

supports and encourages the gainful employment of citizens with disabilities. It is expressly understood and agreed that any articles that are the subject of, or required to carry out, the resulting Contract shall be purchased from a nonprofit agency for the blind or for the severely handicapped that is qualified pursuant to Chapter 413, Florida Statutes, in the same manner and under the same procedures set forth in Section 413.036(1) and (2), Florida Statutes; and for purposes of the resulting Contract the person, firm or other business entity carrying out the provisions of the resulting Contract shall be deemed to be substituted for the state agency insofar as dealings with such qualified nonprofit agency are concerned. Additional information about the designated nonprofit agency and the products it offers is available at http://www.respectofflorida.org. The successful vendor shall describe how it will support the use of RESPECT in providing the services/items being procured under the resulting Contract.

e. Prison Rehabilitative Industries and Diversified Enterprises, Inc. (PRIDE): The

State supports and encourages the use of Florida Correctional work programs. It is expressly understood and agreed that any articles which are the subject of, or required to carry out, the resulting Contract shall be purchased from the corporation identified under Chapter 946, Florida Statutes, in the same manner and under the same procedures set forth in Section 946.515(2) and (4), Florida Statutes; and for purposes of the resulting Contract the person, firm or other business entity carrying out the provisions of the resulting Contract shall be deemed to be substituted for this agency insofar as dealings with such corporation are concerned. Additional information about PRIDE and the products it offers is available at http://www.pride-enterprises.org/. The successful vendor shall describe how it will support the use of PRIDE in providing the services/items being procured under the resulting Contract.

12. Federal Law Requirements and Approval

Approval from the Centers for Medicare and Medicaid Services (CMS) is required before the Agency will execute a Contract resulting from this ITN. Every effort will be made by the Agency both before and after award to facilitate rapid approval. The Agency shall amend the resulting Contract(s) to include additional federal requirements as needed.

13. State Law Requirements and Approval Every effort will be made by the Agency both before and after award to facilitate rapid approval of any required state approvals. The Agency shall amend the resulting Contract(s) to include additional state requirements as needed.



http://www.pride-enterprises.org/



14. MyFloridaMarketPlace Vendor Registration and Transaction Fee

a. MyFloridaMarketPlace Vendor Registration

The vendor is exempt under Rule 60A-1.030(3)d(ii), Florida Administrative Code, from being required to register in MyFloridaMarketPlace for the resulting Contract(s).

b. MyFloridaMarketPlace Transaction Fee

The resulting Contract(s) have been exempted by the Florida Department of Management Services from paying the one percent (1%) transaction fee per Rule 60A-1.032(1)(g), Florida Administrative Code.

15. Florida Department of State

The successful vendor shall be registered with the Florida Department of State as an entity authorized to transact business in the State of Florida by the effective date of the resulting Contract.

16. Certification Regarding Debarment and Suspension

If the Contract to be awarded as a result of this ITN is funded in part by federal funds that exceed the $25,000 requirement, the successful vendor shall be required to sign a Certificate Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion as part of the contracting process.

17. Contract Execution Please see Exhibit C-11 for Standard Contract; Business Associate Agreement; Certification Regarding Lobbying Certification for Contracts, Grants, Loans and Cooperative Agreements; and Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Contracts/Subcontracts which will be required submissions at time of Contract execution. A copy of the proposed standard Contract containing all requirements is included as Exhibit C-11, Standard Contract. The prospective vendor should closely review the requirements contained in the proposed Standard Contract. Modifications proposed by the prospective vendor may not be considered. This ITN, including all its addenda, the Agency’s written response to written inquiries, and the successful vendor’s response to all awarded Regions shall be incorporated by reference in the final Contract document.

D. Contract Implementation

1. Proposed Roll-out Schedule

The Agency anticipates rolling-out MMA plans under the SMMC program on a regional basis. The Agency will establish a regional roll-out schedule which outlines deadlines for plan readiness documentation, plan readiness deadlines and enrollment effective dates by Region.



Due to the need to establish capitation rates for Specialty Plans serving Specialty Populations other than HIV/AIDS Population and the Child Welfare Population, the Agency anticipates rolling-out Specialty Plans for Other Specialty Populations on a different schedule than MMA plans. The Agency does not guarantee that any Managed Care Plan will receive any particular enrollment level. The Agency will publish a proposed regional roll-out schedule and plan readiness review tools prior to the anticipated Contract execution date. Any published schedule is subject to change and provided for planning purposes only.

2. Readiness Review Prior to enrolling recipients in a Managed Care Plan in each Region in which a successful vendor receives a resulting Contract, the Agency will conduct a plan-specific readiness review to assess the Managed Care Plan’s readiness and ability to provide services to recipients. The plan readiness review may include, but is not limited to, desk and onsite review of plan policies and procedures, and corresponding documents, the plan’s provider network and corresponding Contracts, a walk-through of the plan’s operations, system demonstrations, and interviews with plan staff. The scope of the plan readiness review may include any and all Contract requirements, as determined by the Agency. The Agency will not enroll recipients into a Managed Care Plan until the Agency has determined that the Managed Care Plan meets all Contract requirements. The Managed Care Plan shall provide the Agency, prior to Contract execution and at any time upon request of the Agency, with sufficient evidence that the Managed Care Plan has the capacity to provide covered services to all enrollees up to the maximum enrollment level, including evidence that the Managed Care Plan: (1) Maintains a Region wide network of providers offering an appropriate range of

services in sufficient numbers to meet the access standards established by the Agency, pursuant to Section 409.967(2)(c)(1), Florida Statutes; and

(2) Maintains a sufficient number, mix and geographic distribution of providers, including

providers who are accepting new Medicaid patients as specified in s. 1932(b)(5) of the Social Security Act, as enacted by s. 4704(a) of the Balanced Budget Act of 1997.

If a Managed Care Plan does not meet the plan readiness review deadlines for their respective Region, as indicated above, the Agency will grant an extension for the Managed Care Plan to correct deficiencies; however, the Managed Care Plan will lose the initial enrollment of eligible recipients into their respective Region and will lose their transition enrollment, if applicable. After an extension is granted by the Agency, the Managed Care Plan will have until the penultimate Saturday before the respective Region’s enrollment effective date, as established by the Agency, to be deemed ready for recipient enrollment. If a Managed Care Plan is not deemed ready for recipient enrollment by the Agency by the penultimate Saturday before the respective Region enrollment effective date, the Contract between the Managed Care Plan and the Agency will be terminated. If a Managed Care Plan received an additional Contract award pursuant to Section 409.966(3)(e), Florida Statutes, and fails to meet plan readiness review criteria in Region 1



or Region 2 by the deadlines as established by the Agency, the Agency shall terminate the additional awarded Region(s) Contract(s) immediately if recipients have not been enrolled into the additional Region or one hundred eighty (180) days after the respective Region 1 and/or 2 termination if recipients are already enrolled in the additional awarded Region(s).

3. Transition Enrollment

Per Section 409.977(1), Florida Statutes, during the initial roll-out of MMA plans under the SMMC program, recipients currently enrolled in a Medicaid health plan who do not choose a Managed Care Plan within the recipient choice timeframes indicated on the recipient notification letter, will be automatically assigned to their existing plan, if that Medicaid health plan has been awarded a MMA Contract in the Region and meets plan readiness deadlines as established by the Agency, unless an applicable Specialty Plan is available. Per Section 409.977(1), Florida Statutes, if a Specialty Plan is available during the initial roll-out to accommodate a specific condition or diagnosis as specified in the resulting Contract, recipients meeting Specialty Plan criteria who do not choose a Managed Care Plan within the recipient choice timeframes indicated on the recipient notification letter will be automatically assigned to the applicable Specialty Plan. If a Specialty Plan becomes available at some time after the initial roll-out of MMA plans during the first Contract year, recipients meeting Specialty Plan criteria may elect to enroll in an applicable Specialty Plan.

Per Section 409.974(3), Florida Statutes, participation by Specialty Plans shall be subject to the same procurement requirements as all other prospective vendors submitting bids for the SMMC MMA program. The aggregate enrollment of all Specialty Plans in a Region may not exceed ten percent (10%) of the total enrollees of that Region.

The Agency does not guarantee that any Managed Care Plan will receive any particular enrollment level.

4. Enrollment Levels Managed Care Plans shall Contract with and maintain provider network access ratios, as specified by the resulting Contract, sufficient to meet the recipient enrollment levels, by Region, as indicated in the Required Enrollment Levels table below. Managed Care Plans may request higher maximum enrollment levels during the plan readiness review, if desired, but all Managed Care Plans must be able to serve the number of recipients listed below, at a minimum. The Agency used the following formula to determine the required enrollment levels: Enrollment Level = (100% total eligible population / minimum statutorily required plans) x 2

Required Enrollment Levels

Region Total Elig. Population

ITN Enrollment Level

1 88,468 88,468

Per Section 409.974(3), Florida Statutes, the aggregate enrollment of all Specialty Plans in a Region may not exceed ten percent (10%) of the total enrollees of that Region.



The above enrollment level is subject to change and, once contracted, the Agency may update on an annual or more frequent basis based on fluctuations in the total eligible population for MMA managed care enrollment. The Agency does not guarantee that any Managed Care Plan will receive any particular enrollment level; however, the maximum enrollment level indicated in the resulting Contract may not be exceeded unless a plan-specific enrollment level increase has been approved by the Agency.




Section II. Special Terms and Conditions

A. Applicable Laws and Regulations

The successful vendor agrees to comply with all applicable federal and state laws and regulations, including but not limited to: Title 42 Code of Federal Regulations (CFR) Chapter IV, Subchapter C; Title 45 CFR, Part 74, General Grants Administration Requirements; Chapter 409, Florida Statutes; all applicable standards, orders or regulations issued pursuant to the Clean Air Act of 1970 as amended (42 USC 1857, et seq.); Title VI of the Civil Rights Act of 1964 (42 USC 2000d) in regard to persons served; 42 CFR 431, Subpart F; Section 504 of the Rehabilitation Act of 1973, as amended; 29 USC 794, which prohibits discrimination on the basis of handicap in programs and activities receiving or benefiting from federal financial assistance; the Age Discrimination Act of 1975, as amended; 42 USC 6101 et. seq., which prohibits discrimination on the basis of age in programs or activities receiving or benefiting from federal financial assistance; the Omnibus Budget Reconciliation Act of 1981, P.L. 97-35, which prohibits discrimination on the basis of sex and religion in programs and activities receiving or benefiting from federal financial assistance; the Medicare-Medicaid Fraud and Abuse Act of 1978; other federal omnibus budget reconciliation acts; Americans with Disabilities Act (42 USC 12101, et. seq.); and the Balanced Budget Act of 1997. The resulting Contract may be subject to changes in federal and state law, rules or regulations.

B. Audits/Monitoring

The Agency may conduct, or have conducted, performance and/or compliance reviews, reviews of specific records or other data as determined by the Agency. The Agency may conduct a review of a sample of analyses performed by the successful vendor to verify the quality of the successful vendor’s analyses. Reasonable notice shall be provided for reviews conducted at the successful vendor’s place of business; however, Medicaid Program Integrity reviews predicated upon complaint or discovery of alleged fraud or abuse are exempt from the requirement of prior notice. Reviews may include, but shall not be limited to, reviews of procedures, computer systems, beneficiary records, accounting records, and internal quality control reviews. The successful vendor shall work with any reviewing entity selected by the state. During the resulting Contract period, these records shall be available at the successful vendor’s office, during normal business hours (8 a.m. – 5 p.m.). After the resulting Contract period and for six (6) years following, the records shall be available at the successful vendor’s chosen location subject to the approval of the Agency. If the records need to be sent to the Agency, the successful vendor shall bear the expense of delivery. Prior approval of the disposition of the successful vendor and subcontractor records must be requested and approved by the Agency if the resulting Contract or subcontract is continuous. The successful vendor shall comply with 45 CFR, Part 74, with respect to audit requirements of federal Contracts administered through state and local public agencies. In these instances, audit responsibilities have been delegated to the State and are subject to the on-going audit requirements of the State of Florida and of the Agency.



C. Inspection of Records and Work Performed

The State and its authorized representatives shall, at all reasonable times, have the right to enter the successful vendor’s premises, or other places where duties under the resulting Contract are performed. All inspections and evaluations shall be performed in such a manner as not to unduly delay work.

The successful vendor shall retain all financial records, supporting documents, statistical records, and any other documents (including electronic storage media) pertinent to performance under the resulting Contract for a period of six (6) years after termination of the resulting Contract, or if an audit has been initiated and audit findings have not been resolved at the end of six (6) years, the records shall be retained until resolution of the audit findings.

Refusal by the successful vendor to allow access to all records, documents, papers, letters, other materials or on-site activities related to resulting Contract performance shall constitute a breach of the resulting Contract. The right of the state and its authorized representatives to perform inspections shall continue for as long as the successful vendor is required to maintain records. The successful vendor will be responsible for all storage fees associated with the medical records maintained under the resulting Contract. The successful vendor is also responsible for the shredding of medical records that meet the retention schedule noted above.

Failure to retain records as required may result in cancellation of the resulting Contract. The Agency shall give the successful vendor advance notice of cancellation pursuant to this provision and shall pay the successful vendor only those amounts that are earned prior to the date of cancellation in accordance with the terms and conditions of the resulting Contract. Performance by the Agency of any of its obligations under a Contract awarded pursuant to this ITN shall be subject to the successful vendor’s compliance with this provision.

D. Accounting

The successful vendor shall maintain an accounting system and employ accounting procedures and practices that conform to generally accepted accounting principles and standards and comport with financial requirements delineated within 69O-137.002(5), Florida Administrative Code. All charges applicable to the resulting Contract shall be readily ascertainable from such records. The successful vendor is required to submit annual financial audits to the Agency within thirty (30) calendar days of receipt.

E. Subcontracting

The successful vendor shall not subcontract, assign, or transfer any work identified under this ITN or the resulting Contract, with the exception of those subcontractors identified in the prospective vendor’s response, without prior written consent of the Agency.

The vendor is responsible for all work performed under the Contract resulting from this ITN. No subcontract that the vendor enters into with respect to performance under the resulting Contract shall in any way relieve the vendor of any responsibility for performance of its



duties. The successful vendor shall assure that all tasks related to the subcontract are performed in accordance with the terms of the resulting Contract. The Agency supports diversity in its Procurement Program and requests that all subcontracting opportunities afforded by this ITN enthusiastically embrace diversity. The award of subcontracts should reflect the full diversity of the citizens of the State of Florida. Prospective vendors can contact the Office of Supplier Diversity at (850) 487-0915 for information on minority vendors who may be considered for subcontracting opportunities.

F. HIPAA Compliance

The successful vendor must ensure it meets all federal regulations regarding standards for privacy and individually identifiable health information as identified in the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and Florida Statutes.

G. Confidentiality of Beneficiary Information

All personally identifiable beneficiary information obtained by the successful vendor shall be treated as privileged and confidential information and shall be used only as authorized for purposes directly related to the administration of the resulting Contract. The successful vendor must have a process that specifies that patient-specific information remains confidential, is used solely for the purposes of data analysis and other vendor responsibilities under the Contract resulting from this ITN, and is exchanged only for the purpose of conducting a review or other duties outlined in the resulting Contract. Any patient-specific information received by the successful vendor can be shared only with those agencies that have legal authority to receive such information and cannot be otherwise transmitted for any purpose other than those for which the successful vendor is retained by the Agency. The successful vendor must have in place written confidentiality policies and procedures to ensure confidentiality and to comply with all federal and state laws (including the Health Insurance Portability and Accountability Act [HIPAA]) of 1996 governing confidentiality, including electronic treatment records, facsimile mail, and electronic mail). The successful vendor’s subcontracts must explicitly state expectations about the confidentiality of information, and the subcontractor is held to the same confidentiality requirements as the successful vendor. If provider-specific data are released to the public, the successful vendor shall have policies and procedures for exercising due care in compiling and releasing such data that address statutory protections of quality assurance and confidentiality while assuring that open records requirements of Chapter 119, Florida Statutes, are met. Any releases of information to the media, the public, or other entities require prior approval from the Agency.



H. Work Authorization Program

The Immigration Reform and Control Act of 1986 prohibits employers from knowingly hiring illegal workers. The successful vendor shall only employ individuals who may legally work in the United States – either U.S. citizens or foreign citizens who are authorized to work in the U.S. The successful vendor shall use the U.S. Department of Homeland Security’s E-Verify Employment Eligibility Verification system, https://e-verify.uscis.gov/emp, to verify the employment eligibility of all new employees hired by the successful vendor during the term of the Contract resulting from this ITN and shall also include a requirement in its subcontracts that the subcontractor utilize the E-Verify system to verify the employment eligibility of all new employees hired by the subcontractor performing work or providing services pursuant to the Contract resulting from this ITN.

I. EEO Compliance

A successful vendor awarded a Contract pursuant to this ITN shall not discriminate in its employment practices with respect to race, color, religion, age, sex, marital status, political affiliation, national origin, or handicap except as provided by law.

J. Patents, Royalties, Copyrights, Right to Data and Sponsorship Statement

The successful vendor, without exception, shall indemnify and hold harmless the Agency and its employees from liability of any nature or kind, including cost and expenses for or on account of any copyrighted, patented, or unattended invention, process, or article manufactured or supplied by the successful vendor. The successful vendor has no liability when such claim is solely and exclusively due to the combination, operation or use of any article supplied hereunder with equipment or data not supplied by the successful vendor or is based solely and exclusively upon the Agency’s alteration of the article. The Agency shall provide prompt written notification of a claim of copyright or patent infringement and shall afford the successful vendor full opportunity to defend the action and control the defense. Further, if such a claim is made or is pending, the successful vendor may, at its option and expense procure for the Agency the right to continue the use of, replace or modify the article to render it non-infringing (if none of the alternatives are reasonably available, the Agency agrees to return the article on request to the successful vendor and receive reimbursement, if any, as may be determined by a court of competent jurisdiction). If the successful vendor brings to the performance of the resulting Contract a pre-existing patent or copyright, the successful vendor shall retain all rights and entitlements to that pre-existing patent or copyright, unless this ITN and the resulting Contract provide otherwise. If the successful vendor uses any design, device, or materials covered by letter, patent, or copyright, it is mutually agreed and understood without exception that the proposed prices shall include all royalties or cost arising from the use of such design, device, or materials in any way involved in the work. Prior to the initiation of services under the resulting Contract, the successful vendor shall disclose, in writing, all intellectual properties relevant to the

https://e-verify.uscis.gov/emp



performance of the resulting Contract which the successful vendor knows, or should know, could give rise to a patent or copyright. The successful vendor shall retain all rights and entitlements to any pre-existing intellectual property which is so disclosed. Failure to disclose will indicate that no such property exists. The Agency shall then have the right to all patents and copyrights which arise as a result of performance under the resulting Contract as provided in this section. If any discovery or invention arises or is developed in the course of, or as a result of, work or services performed under the resulting Contract, or in any way connected herewith, the successful vendor shall refer the discovery or invention to the Agency for a determination whether patent protection will be sought in the name of the State of Florida. Any and all patent rights accruing under or in connection with the performance of the resulting Contract are hereby reserved to the State of Florida. All materials to which the Agency is to have patent rights or copyrights shall be marked and dated by the successful vendor in such a manner as to preserve and protect the legal rights of the Agency. Where activities supported by the Contract resulting from this ITN produce original writing, sound recordings, pictorial reproductions, drawings or other graphic representation and works of any similar nature, the Agency has the right to use, duplicate and disclose such materials in whole or in part, in any manner, for any purpose whatsoever and to have others acting on behalf of the Agency to do so. If the materials so developed are subject to copyright, trademark, or patent, legal title and every right, interest, claim, or demand of any kind in and to any patent, trademark or copyright, or application for the same, shall vest in the State of Florida, Department of State for the exclusive use and benefit of the state. Pursuant to Section 286.021, Florida Statutes, no person, firm, corporation, including parties to the resulting Contract shall be entitled to use the copyright, patent, or trademark without the prior written consent of the Florida Department of State. The Agency shall have unlimited rights to use, disclose, or duplicate, for any purpose whatsoever, all information and data developed, derived, documented, or furnished by the successful vendor under any Contract resulting from this ITN. Pursuant to Section 286.25, Florida Statutes, all non-governmental vendors must assure that all notices, information pamphlets, press releases, advertisements, descriptions of the sponsorship of the program, research reports, and similar public notices prepared and released by the successful vendor shall include the statement: “Sponsored by (name of successful vendor) and the State of Florida, Agency for Health Care Administration.” If the sponsorship reference is in written material, the words, “State of Florida, Agency for Health Care Administration” shall appear in the same size letters or type as the name of the organization. All rights and title to works for hire under the resulting Contract, whether patentable or copyrightable or not, shall belong to the Agency and shall be subject to the terms and conditions of this ITN and the resulting Contract. The computer programs, materials and other information furnished by the Agency to the successful vendor hereunder shall be and remain the sole and exclusive property of the Agency, free from any claim or right of retention by or on behalf of the successful vendor. The services and products listed in this ITN and the resulting Contract shall become the property of the Agency upon the successful vendor’s performance and delivery thereof. The



successful vendor hereby acknowledges that said computer programs, materials and other information provided by the Agency to the successful vendor hereunder, together with the products delivered and services performed by the successful vendor hereunder, shall be and remain confidential and proprietary in nature to the extent provided by Chapter 119, F. S., and that the successful vendor shall not disclose, publish or use same for any purpose other than the purposes provided in this ITN and the resulting Contract; however, upon the successful vendor first demonstrating to the Agency’s satisfaction that such information, in part or in whole, (1) was already known to the successful vendor prior to its receipt from the Agency; (2) became known to the successful vendor from a source other than the Agency; or (3) has been disclosed by the Agency to third parties without restriction, the successful vendor shall be free to use and disclose same without restriction, except that the Vendor shall not take any action that would infringe upon the Agency’s ownership.. Upon completion of the successful vendor’s performance or otherwise cancellation or termination of the resulting Contract, the successful vendor shall surrender and deliver to the Agency, freely and voluntarily, all of the above-described information remaining in the successful vendor's possession. The successful vendor warrants that all materials produced hereunder will be of original development by the successful vendor and will be specifically developed for the fulfillment of this ITN and the resulting Contract and will not knowingly infringe upon or violate any patent, copyright, trade secret or other property right of any third party, and the successful vendor shall indemnify and hold the Agency harmless from and against any loss, cost, liability or expense arising out of any breach or claimed breach of this warranty. The terms and conditions specified in this section shall also apply to any subcontract made under the resulting Contract. The successful vendor shall be responsible for informing the subcontractor of the provisions of this section and obtaining disclosures.

K. Misuse of Symbols, Emblems, or Names in Reference to Medicaid No person or Managed Care Plan may use, in connection with any item constituting an advertisement, solicitation, circular, book, pamphlet or other communication, or a broadcast, telecast, or other production, alone or with other words, letters, symbols or emblems the words “Medicaid,” “Agency for Health Care Administration,” or “Department of Elder Affairs,” except as required in the Agency’s Standard Contract, Section I., Item N., Sponsorship, unless prior written approval is obtained from the Agency. Specific written authorization from the Agency is required to reproduce, reprint, or distribute any Agency form, application, or publication for a fee. State and local governments are exempt from this prohibition. A disclaimer that accompanies the inappropriate use of program or Agency or Department of Elder Affairs terms does not provide a defense. Each piece of mail or information constitutes a violation.

L. State Ownership

The Agency shall have the right to use, disclose or duplicate all information and data developed, derived, documented or furnished by the Managed Care Plan resulting from the resulting Contract. Nothing herein shall entitle the Agency to disclose to third parties data or information that would otherwise be protected from disclosure by state or federal law.



M. Independent Provider

It is expressly agreed that the Managed Care Plan and any agents, officers, and/or employees of the Managed Care Plan or any subcontractors, in the performance of the resulting Contract shall act in an independent capacity and not as officers and employees of the Agency or the State of Florida. It is further expressly agreed that the resulting Contract shall not be construed as a partnership or joint venture between the Managed Care Plan or any subcontractor and the Agency and the State of Florida.

N. Force Majeure The Agency shall not be liable for any excess cost to the Managed Care Plan if the Agency's failure to perform the Contract arises out of causes beyond the control and without the result of fault or negligence on the part of the Agency. In all cases, the failure to perform must be beyond the control without the fault or negligence of the Agency. The Managed Care Plan shall not be liable for performance of the duties and responsibilities of the Contract when its ability to perform is prevented by causes beyond its control. These acts must occur without the fault or negligence of the Managed Care Plan. These include destruction to the facilities due to hurricanes, fires, war, riots and other similar acts.

O. Waiver

No covenant, condition, duty, obligation, or undertaking contained in or made a part of the Contract shall be waived except by written agreement of the parties, and forbearance or indulgence in any other form or manner by either party in any regard whatsoever shall not constitute a waiver of the covenant, condition, duty, obligation, or undertaking to be kept, performed, or discharged by the party to which the same may apply. Until complete performance or satisfaction of all such covenants, conditions, duties, obligations, or undertakings, the other party shall have the right to invoke any remedy available under law or equity notwithstanding any such forbearance or indulgence.

P. Contract Variation

If any provision of the resulting Contract (including items incorporated by reference) is declared or found by the Agency or the judiciary to be illegal, unenforceable or void, then both the Agency and the Managed Care Plan shall be relieved of all obligations arising under such provisions. If the remainder of the Contract is capable of performance, it shall not be affected by such declaration or finding and shall be fully performed. In addition, if the laws or regulations governing the resulting Contract should be amended and the Agency or the judiciary interpret the changes to render the fulfillment of the Contract impossible or economically infeasible, both the Agency and the Managed Care Plan shall be discharged from further obligations created under the terms of the Contract. However, such declaration or finding shall not affect any rights or obligations of either party to the extent that such rights or obligations arise from acts performed or events occurring prior to the effective date of such declaration or finding.



Q. Venue By responding to this ITN, respondents agree and will consent, in the event of any legal challenges to this procurement, if the Agency requires that: 1) Hearings and depositions for any administrative or other litigation related to this

procurement shall be held in Leon County Florida. 2) If a specifications challenge is raised in this MMA ITN and/or in the MMA ITN for the

other Regions of the State, all such specifications challenges shall be consolidated into one.

3) In any challenge to this MMA ITN and/or the MMA ITN for the other Regions of the State, discovery shall be consolidated for all challenges. At a minimum, consolidated discovery would provide that a single deposition for each State witness would serve as the deposition for that witness for all challenges in which that witness is called to testify (as opposed to separate depositions of the same witness for each challenge). Respondents will make their best good faith efforts to implement any other method by which the discovery process may be applied across the board to all challenges.

4) If a challenge to the award of this MMA ITN is raised in this Region and/or in other Regions of the State, all such challenges shall be consolidated into one.

Respondents (and their successors, including but not limited to their parent(s), affiliates, subsidiaries, subcontractors, assigns, heirs, administrators, representatives and trustees) acknowledge that this ITN (including but not limited to the resulting Contract, exhibits, attachments, or amendments) is not a rule nor subject to rulemaking under Chapter 120 (or its successor) of the Florida Statutes and is not subject to challenge as a rule or non-rule policy under any provision of Chapter 120, Florida Statutes.

The Contract resulting from this ITN shall be delivered in the State of Florida and shall be construed in accordance with the laws of Florida. Wherever possible, each provision of the resulting Contract shall be interpreted in such a manner as to be effective and valid under applicable law, but if any provision shall be found ineffective, then to the extent of such prohibition or invalidity, that provision shall be severed without invalidating the remainder of such provision or the remaining provisions of the resulting Contract. Any action hereon or in connection herewith shall be brought in Leon County, Florida.

R. Attorney’s Fees

In the event of a dispute, each party to the Contract shall be responsible for its own attorneys’ fees, except as otherwise provided by law.

S. Legal Action Notification

The Managed Care Plan shall give the Agency, by certified mail, immediate written notification (no later than thirty (30) calendar days after service of process) of any action or suit filed or of any claim made against the Managed Care Plan by any subcontractor, vendor, or other party that results in litigation related to the Contract resulting from this ITN for disputes or damages exceeding the amount of $50,000. In addition, the Managed Care Plan shall immediately advise the Agency of the insolvency of a subcontractor or of the filing of a petition in bankruptcy by or against a principal subcontractor.



T. Authority to Act

Any person executing the Contract resulting from this ITN or any documents, instruments or assurances, created, presented or reasonably necessary or appropriate to carry out the full intent and purpose of the Contract, in a representative capacity, hereby warrants to the Agency that it has implied, express or delegated authority to enter into, execute, attest or certify the Contract or aforementioned documents on behalf of such party which it represents. The Managed Care Plan shall not raise the fact that a person executing a document, instrument or assurance as set forth herein lacks authority to bind the Managed Care Plan for which it is representing as a defense to the enforcement of the Contract or other document executed in connection with the Contract.

U. Proof of Execution by Electronic Copy or Facsimile

For purposes of executing the Contract resulting from this ITN or any documents, instruments and assurances created, presented or reasonably necessary or appropriate to carry out the full intent and purpose of the Contract, a document signed or electronically signed and transmitted by facsimile, email or other form of electronic transmission is to be treated as an original document. The signature or electronic signature of any party thereon, for purposes hereof, is to be considered as an original signature, and the document transmitted is to be considered to have the same binding effect as an original signature on an original document. At the request of the Agency, any document transmitted by facsimile, telecopy, email or other form of electronic transmission is to be executed in original form by the Managed Care Plan. The Managed Care Plan shall not raise the fact that any signature was transmitted through the use of a facsimile, email or other form of electronic transmission as a defense to the enforcement of the Contract or other document executed in connection with the Contract.

V. Remedies Cumulative Except as otherwise expressly provided herein, all rights, powers and privileges conferred hereunder upon the Managed Care Plan are cumulative and not restrictive of those given by law. No remedy herein conferred is exclusive of any other available remedy; but each and every such remedy is cumulative and is in addition to every other remedy given by Contract or now or hereafter existing at law, in equity or by statute.

W. Damages for Failure to Meet Contract Requirements

In addition to remedies available through the Contract resulting from this ITN, in law or equity, the Managed Care Plan shall reimburse the Agency for any federal disallowances or sanctions imposed on the Agency as a result of the Managed Care Plan’s failure.



X. Contract Termination

In addition to the Contract termination terms and conditions outlined in Exhibit C-11, Standard Contract, Section III, Item A., Termination, the Agency will terminate a resulting Contract for the reasons outlined in Attachment D, Scope of Services – Core Provisions, Subsection XII.G, Termination Procedures. These provisions apply equally to vendors who execute a Comprehensive LTC Contract.


EXHIBIT C-1 QUESTIONS TEMPLATE INSTRUCTIONS

AHCA ITN 017-12/13, Exhibit C-1, Page 1 of 1

Instructions for Vendor Submission of Questions: Pursuant to Attachment C, Special Conditions and Instructions, Section I. A. 8, Vendor Questions, the prospective vendor shall utilize Exhibit C-1, Questions Template Instructions, when submitting a written inquiry. Exhibit C-1, Questions Template Instructions, is an excel document and is available for prospective vendors to download at the following link: http://ahca.myflorida.com/Procurements/index.shtml. Questions may be sent by US Mail, email, fax or hand delivered. (Email is preferred and encouraged.) Questions submitted by email are to be submitted to the Agency at the following email address: [email protected]. Prospective vendors submitting questions should include the vendor’s name, a contact name, telephone number and email address with its question submission. See the “sample” entries below; if the question is not relative to a particular ITN section, indicate “General” under “ITN Attachment Identifier”.

VENDOR ITN ATTACHMENT

IDENTIFIER

ATTACHMENT EXHIBIT

IDENTIFIER (IF APPLICABLE

SECTION/SUBSECTION CITE REFERENCE QUESTION

ABC GENERAL NA NA What is the capital of Florida?

ABC C NA I.A.8 Vendor Questions Will the Agency accept vendor questions via email?

ABC C NA I.D.1 Proposed Roll-out Schedule

How is the regional roll-out schedule determined?

ABC C NA II.G Confidentiality of Beneficiary Information

What does “personally identifiable beneficiary information” mean?

ABC C 9 Regional Preference Hierarchy table

Please confirm the most desired region for additional award should be ranked as number 1 in the hierarchy schedule.



EXHIBIT C-2 PAST PERFORMANCE – CLIENT REFERENCE FORM


Vendor’s Name: In the spaces provided below, the respondent shall list all names under which it has operated during the past five (5) years.

If the respondent elects to submit Non-AHCA client references, on the following pages, the respondent shall provide the information indicated for a maximum of three (3) separate, Non-AHCA clients. The clients listed must be for work similar in nature to that specified in this ITN. The same client may not be listed for more than one (1) reference and confidential clients shall not be included. In the event the respondent has had a name change since the time work was performed for a listed reference, the name under which the respondent operated at that time must be provided in the space provided for Vendor’s Name. If the respondent elects to submit Non-AHCA client references, the respondent must include with its response a completed, signed with original signature and dated Evaluation Questionnaire for Past Performance, provided by a maximum of three (3) Non-AHCA identified (in this Exhibit) client references, in individual envelopes that contain a client signature across the sealed flap. The Agency will not accept any Evaluation Questionnaire for Past Performance which is not included with a prospective vendor’s response. If the respondent elects to submit client references and submits a reply as a joint venture or legal partnership, at least one (1) past performance Non-AHCA client reference should be listed for each member of the joint venture or legal partnership, if available. However, the total maximum number of client references to be listed remains three (3). Clients that are listed as subcontractors in the response will not be accepted as Past Performance references under this ITN. References pertaining to the respondents’ parent, affiliate(s) or subsidiary(ies) that have experience similar in nature to that specified in this ITN will be accepted. AHCA will consider a maximum of three (3) clients who will complete an Evaluation Questionnaire for Past Performance, for evaluation scoring. Responses which do not contain client references will receive a score of zero (0) for the past performance evaluation component. AHCA reserves the right to contact references other than those identified by the respondent to obtain additional information regarding past performance. Any information obtained as a result of such contact may be used to determine whether or not the respondent is a “responsible vendor”, as defined in Section 287.012(24), Florida Statutes. Note: Agency for Health Care Administration (AHCA)



NON-AHCA CLIENT REFERENCE #1

Vendor’s Name:

Client’s Name:

Address:

Contract Performance Period:

Location of Services: Brief description of the services performed by the respondent for this client:




Vendor’s Name:

Client’s Name:

Address:





EVALUATION QUESTIONNAIRE FOR PAST PERFORMANCE

Vendor’s Name: Non-AHCA Client Name:

The following questions shall be answered by the vendor’s Non-AHCA client references as indicated in this Exhibit.

Score 1. Briefly describe the services the vendor performed for your organization:

N/A

2. Define the relationship between the vendor and the client reference as one of the following:

(circle one) a. Prime vendor; or b. Subcontractor.

N/A

3. Did the vendor consistently meet all of its performance/milestones deadlines? Yes = 5; No = 0

4. Did vendor maintain open lines of communication with your organization? Yes = 5; No = 0

5. Did the vendor make requested modifications within designated time frames? Yes= 5; No = 0

6. Was the vendor knowledgeable of the contract requirements and scope of work? Yes = 5; No = 0

7. Did the vendor’s policies and procedures meet contract requirements? Yes = 5; No = 0

Total Score:

Client Reference Name (printed)

Title

Client Reference Signature Date

EXHIBIT C-3 REQUIRED CERTIFICATIONS AND STATEMENTS


Vendor’s Name: 1. Acceptance of Contract Terms and Conditions

I hereby certify that should my company be awarded a Contract resulting from this solicitation, it will comply with all terms and conditions specified in this solicitation and contained in the Agency Standard Contract (Exhibit C-11); Attachment A, General Instructions to Respondents; Attachment B, General Contract Instructions; and applicable Exhibits).

AND

2. Statement of No-Involvement

I hereby certify my company had no prior involvement in performing a feasibility study of the implementation of the subject Contract, in drafting of the solicitation or in developing the subject program.

AND 3. Non-Collusion Certification

I hereby certify that all persons, companies, or parties interested in the response as principals are named therein, that the response is made without collusion with any other person, persons, company, or parties submitting a response; that it is in all respects made in good faith; and as the signer of the response, I have authority to legally bind the vendor to the provision of this response.

AND

4. Organizational Conflict of Interest Certification

I hereby certify that, to the best of my knowledge, my company (including its subcontractors, subsidiaries and partners):

Has no existing relationship, financial interest or other activity which creates any actual or potential organizational conflicts of interest relating to the award of a contract resulting from this ITN.

Has included information in its response to this solicitation detailing the existence of actual or potential organizational conflicts of interest and has provided a “Conflict of Interest Mitigation Plan”, as outlined in Attachment C, Section I.B.10.



AND

5. Business Relationship

The respondent shall disclose any business relationship (as defined in Section 409.966 (3)(b), Florida Statutes) with any other eligible Managed Care Plan that is a potential respondent to this ITN. Such disclosure shall include identifying information for each Managed Care Plan, the nature of the business relationship, the current service area of each Managed Care Plan (by line of business), and the signature of the authorized representative for each Managed Care Plan.

The respondent must disclose any business relationship(s) in the space provided below:

6. Encounter Data

I hereby certify my company has the following:

Ability to and will readily provide complete and accurate encounter data to

the Agency as defined by Contract; and Capability to send and receive any claims information directly to the

Agency in standards and timeframes specified by the Agency within sixty (60) days notice.

AND 7. Direct Secure Messaging

I hereby certify my company has the ability to and will encourage network providers to participate in the Agency’s Direct Secure Messaging (DSM) service.



AND

8. Qualification of Plan Eligibility

I hereby certify my company currently operates as one (1) of the following:

HMO Health Maintenance Organization (HMO) and possess a current Florida Certificate of Authority and Health Care Provider Certificate in at least one (1) Florida county.

OR

Provider Service Network (PSN) qualified by Section 409.912(4)(d), Florida Statutes, which is majority owned (over 50%) by a health care provider, group of affiliated providers, public agency, or entity that delivers health services (Section 409.962(13), Florida Statutes), and possess a Florida Third Party Administrator License or a subcontract/letter of agreement with a Florida-licensed Third Party Administrator.

In addition, the respondent shall complete Exhibit C-4, Disclosure of Ownership and Control Interest Statement (CMS 1513).

OR

Other Insurer which meets the ownership and financial requirements of a PSN.

OR

Exclusive Provider Organization (EPO) which meets the licensure requirements of Section 627.6472, Florida Statutes, and the financial requirements of an MMA Capitated Managed Care Plan.

OR

Accountable Care Organization (ACO) which meets the ownership requirements of a PSN and the financial requirements of a Capitated or FFS Managed Care Plan.



AND

9. Complete Medicaid Provider Enrollment Package Submission

I hereby certify my company, if awarded a Contract, shall provide the Agency with an accurate and complete Medicaid Provider Enrollment Application, including all ownership and principal fingerprint cards and processing fees, within thirty (30) days after the Contract award is complete.

AND

10. Required Plan Readiness Documentation

I hereby certify my company, if awarded a Contract, shall submit to the Agency all required Plan Readiness documentation within established timeframes as required in Attachment C, Section I.D.1, Proposed Roll-out Schedule and Section I.D.2, Readiness Review.

AND

11. Certification Regarding Terminated Contracts

I hereby certify that my company (including its subsidiaries and affiliates) has not unilaterally or willfully terminated any previous Contract prior to the end of the Contract with a state or the federal government and has not had a Contract terminated by a state or the federal government for cause, prior to the end of the Contract, within the past seven (7) years, other than those listed on Exhibit C-6, List of Terminated Contracts.

AND

12. Statutorily Required Providers

I hereby certify my company will offer Contracts to all statutorily required providers, which are home medical equipment and supplies providers which meet my company’s quality and fraud prevention and detection standards and accept the lowest price previous negotiated between my company and another such provider. (See Section 409.975(1)(d), Florida Statutes, and Exhibit C-8, Home Medical Equipment and Supplies Providers List.)



Signature below indicates the respondent’s full acknowledgement of; understanding of; and agreement with all of the certifications and statements identified above in Items 1 through 12 as written and without caveat. Respondent Name

Authorized Representative Signature Date Authorized Representative Name Authorized Representative Title

FAILURE TO SUBMIT EXHIBIT C-3 REQUIRED CERTIFICATIONS AND STATEMENTS, SIGNED BY AN AUTHORIZED OFFICIAL, WILL RESULT IN THE REJECTION OF A PROSPECTIVE VENDOR’S RESPONSE.

VENDORS ARE NOT AUTHORIZED TO MODIFY AND/OR MAKE CAVEAT STATEMENTS TO EXHIBIT C-3, REQUIRED CERTIFICATIONS AND STATEMENTS. SUCH ACTIONS WILL RESULT IN REJECTION OF THE VENDOR’S RESPONSE.

General Instructions

For definitions, procedures and requirements, refer to the appropriateRegulations:

Title V – 42CFR 51a.144Title XVIII – 42CFR 420.200 – 206Title XIX – 42CFR 455.100 – 106Title XX – 45CFR 228.72 – 73

Please answer all questions as of the current date. If the yes block forany item is checked, list requested additional information under theRemarks section on page 2, referencing the item number to be continued. If additional space is needed use an attached sheet.

Return the original and second and third copies to the Stateagency; retain the first copy for your files.

This form is to be completed annually. Any substantial delay incompleting the form should be reported to the State survey agency.

DETAILED INSTRUCTIONSThese instructions are designed to clarify certain questions on theform. Instructions are listed in question order for easy reference. Noinstructions have been given for questions considered self-explanatory.

IT IS ESSENTIAL THAT ALL APPLICABLE QUESTIONS BEANSWERED ACCURATELY AND THAT ALL INFORMATION BECURRENT.

Item I (a) Under identifying information specify in what capacity theentity is doing business as (DBA), example, name oftrade or corporation.

(b) For Regional Office Use Only. If the yes box is checked for item VII, the Regional Office will enter the 5-digitnumber assigned by CMS to chain organizations.

Item II - Self-explanatory.

Item III - List the names of all individuals and organizations havingdirect or indirect ownership interests, or controlling interest separatelyor in combination amounting to an ownership interest of 5 percent ormore in the disclosing entity.

Direct ownership interest is defined as the possession of stock, equityin capital or any interest in the profits of the disclosing entity. A disclosing entity is defined as a Medicare provider or supplier, or otherentity that furnishes services or arranges for furnishing services underMedicaid or the Maternal and Child Health program, or health relatedservices under the social services program.

Indirect ownership interest is defined as ownership interest in an entitythat has direct or indirect ownership interest in the disclosing entity.The amount of indirect ownership in the disclosing entity that is held byany other entity is determined by multiplying the percentage of ownership interest at each level. An indirect ownership interest must bereported if it equates to an ownership interest of 5 percent or more inthe disclosing entity. Example: if A owns 10 percent of the stock in acorporation that owns 80 percent of the stock of the disclosing entity,A's interest equates to an 8 percent indirect ownership and must bereported.

INSTRUCTIONS FOR COMPLETING DISCLOSURE OFOWNERSHIP AND CONTROL INTEREST STATEMENT (CMS-1513)

Completion and submission of this form is a condition of participation, certification, or recertification under any of the programs established by titles V,XVIII, XIX, and XX, or as a condition of approval or renewal of a contractor agreement between the disclosing entity and the Secretary of appropriateState agency under any of the above-titled programs, a full and accurate disclosure of ownership and financial interest is required. Failure to submitrequested information may result in a refusal by the Secretary or appropriate State agency to enter into an agreement or contract with any suchinstitution or in termination of existing agreements.

SPECIAL INSTRUCTIONS FOR TITLE XX PROVIDERSAll title XX providers must complete part II (a) and (b) of this form. Only those title XX providers rendering medical, remedial, or health related home-maker services must complete parts II and III. Title V providers must complete parts II and Ill.

Controlling interest is defined as the operational direction or management of a disclosing entity which may be maintained by any orall of the following devices: the ability or authority, expressed orreserved, to amend or change the corporate identity (i.e., joint ventureagreement, unincorporated business status) of the disclosing entity; theability or authority to nominate or name members of the Board ofDirectors or Trustees of the disclosing entity; the ability or authority,expressed or reserved, to amend or change the by-laws, constitution,or other operating or management direction of the disclosing entity; theright to control any or all of the assets or other property of the disclosing entity upon the sale or dissolution of that entity; the ability orauthority, expressed or reserved, to control the sale of any or all of theassets, to encumber such assets by way of mortage or other indebtedness, to dissolve the entity, or to arrange for the sale or transfer of the disclosing entity to new ownership or control.

Items IV – VII - Changes in Provider Status

Change in provider status is defined as any change in managementcontrol. Examples of such changes would include: a change in Medicalor Nursing Director, a new Administrator, contracting the operation ofthe facility to a management corporation, a change in the compositionof the owning partnership which under applicable State law is notconsidered a change in ownership, or the hiring or dismissing of anyemployees with 5 percent or more financial interest in the facility or inan owning corporation, or any change of ownership.

For Items IV – VII, if the yes box is checked, list additional informationrequested under Remarks. Clearly identify which item is being continued.

Item IV - (a & b) If there has been a change in ownership within thelast year or if you anticipate a change, indicate the date in theappropriate space.

Item V - If the answer is yes, list name of the management firm andemployer identification number (EIN), or the name of the leasingorganization. A management company is defined as any organizationthat operates and manages a business on behalf of the owner of thatbusiness, with the owner retaining ultimate legal responsibility foroperation of the facility.

Item VI - If the answer is yes, identify which has changed(Administrator, Medical Director, or Director of Nursing) and the datethe change was made. Be sure to include name of the newAdministrator, Director of Nursing or Medical Director, as appropriate.

Item VII - A chain affiliate is any free-standing health care facility that iseither owned, controlled, or operated under lease or contract by anorganization consisting of two or more free-standing health carefacilities organized within or across State lines which is under theownership or through any other device, control and direction of acommon party. Chain affiliates include such facilities whether public,private, charitable or proprietary. They also include subsidiaryorganizations and holding corporations. Provider-based facilities, suchas hospital-based home health agencies, are not considered to bechain affiliates.

Item VIII - If yes, list the actual number of beds in the facility now andthe previous number.

DEPARTMENT OF HEALTH AND HUMAN SERVICESCENTERS FOR MEDICARE & MEDICAID SERVICES

Form ApprovedOMB No. 0938-0086

EXHIBIT C-4

DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT, CMS 1513


I. Identifying Information

DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT

(a) Name of Entity D/B/A

Street Address

(b) (To be completed by CMS Regional Office) Chain Affiliate No. ■■ ■■ ■■ ■■ ■■ LB1

Provider No.

City, County, State

Vendor No. Telephone No.

Zip Code

II. Answer the following questions by checking "Yes" or "No." If any of the questions are answered "Yes," list names and addresses of individuals or corporations under Remarks on page 2. Identify each item number to be continued.

(a) Are there any individuals or organizations having a direct or indirect ownership or control interest of 5 percent or more in the institution, organizations, or agency that have been convicted of a criminal offense related to the involvement of such persons, or organizations in any of the programs established by titles XVIII, XIX, or XX?

■■ Yes ■■ No LB2

(b) Are there any directors, officers, agents, or managing employees of the institution, agency or organization who have ever been convicted of a criminal offense related to their involvement in such programs established by titles XVIII, XIX, or XX?


(c) Are there any individuals currently employed by the institution, agency, or organization in a managerial, accounting, auditing, or similar capacity who were employed by the institution's, organization's, or agency's fiscal intermediary or carrier within the previous 12 months? (Title XVIII providers only)


Ill. (a) List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names and addresses under "Remarks" on page 2. If more than one individual isreported and any of these persons are related to each other, this must be reported under Remarks.

Name Address EIN

(b) Type of Entity:■■ Sole Proprietorship ■■ Partnership ■■ Corporation LB6

■■ Unincorporated Associations ■■ Other (Specify)

LB5

(c) If the disclosing entity is a corporation, list names, addresses of the Directors, and EINs for corporations under Remarks.

Check appropriate box for each of the following questions:(d) Are any owners of the disclosing entity also owners of other Medicare/Medicaid facilities? (Example: sole proprietor, partnership or members of Board

of Directors.) If yes, list names, addresses of individuals and provider numbers.■■ Yes ■■ No LB7

Name Address Provider Number

DEPARTMENT OF HEALTH AND HUMAN SERVICES Form ApprovedCENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0086

CMS-1513 (5/86) Page 1

EXHIBIT C-4



DEPARTMENT OF HEALTH AND HUMAN SERVICES Form ApprovedCENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0086

CMS-1513 (5/86) Page 2

IV. (a) Has there been a change in ownership or control within the last year?If yes, give date _____________ ■■ Yes ■■ No LB8

(b) Do you anticipate any change of ownership or control within the year?If yes, when? _______________ ■■ Yes ■■ No LB9

(c) Do you anticipate filing for bankruptcy within the year?If yes, when? _______________ ■■ Yes ■■ No LB10

V. Is this facility operated by a management company, or leased in whole or part by another organization? If yes, give date of change in operations ____________ ■■ Yes ■■ No LB11

VI. Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year?■■ Yes ■■ No LB12

VII. (a) Is this facility chain affiliated? (If yes, list name, address of Corporation, and EIN)Name EIN # ■■ Yes ■■ No LB13

Address

LB14

VII. (b) If the answer to Question VII.a. is No, was the facility ever affiliated with a chain? (If yes, list Name, Address of Corporation, and EIN)Name EIN # ■■ Yes ■■ No LB18

Address

LB19

VIII. Have you increased your bed capacity by 10 percent or more or by 10 beds, whichever is greater, within the last 2 years?

■■ Yes ■■ No LB15If yes, give year of change ____________

Current beds _____________ LB16 Prior beds _____________ LB17

WHOEVER KNOWINGLY AND WILLFULLY MAKES OR CAUSES TO BE MADE A FALSE STATEMENT OR REPRESENTATION OF THIS STATEMENT, MAYBE PROSECUTED UNDER APPLICABLE FEDERAL OR STATE LAWS. IN ADDITION, KNOWINGLY AND WILLFULLY FAILING TO FULLY AND ACCURATELYDISCLOSE THE INFORMATION REQUESTED MAY RESULT IN DENIAL OF A REQUEST TO PARTICIPATE OR WHERE THE ENTITY ALREADY PARTICIPATES,A TERMINATION OF ITS AGREEMENT OR CONTRACT WITH THE STATE AGENCY OR THE SECRETARY, AS APPROPRIATE.

Name of Authorized Representative (Typed)

Signature

Title

Date

Remarks

EXHIBIT C-4



According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid 0MB control number. The valid 0MB control number for this information collection is 0938-0086. The time required to complete this information collection is estimated to average 30 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review theinformation collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to CMS,7500 Security Boulevard, N2-14-26, Baltimore, Maryland 21244-1850.

EXHIBIT C-4



EXHIBIT C-5 MANAGED MEDICAL ASSISTANCE (MMA) PROVIDER SERVICE NETWORK (PSN) PROVIDER

OWNERSHIP INTEREST DISCLOSURE REPORT


Vendor’s Name: Directions: List each PSN respondent owner included on the completed CMS-1513, Disclosure of Ownership and Control Interest Statement in Column (1). Include direct and indirect owners. In Column 2, specify the percent of indirect and direct ownership of each owner in the PSN respondent (see Item III on the CMS-1513 Detailed Instructions for information on direct and indirect ownership interest). In Column (3), indicate if the owner is currently a Medicaid provider (Yes or No). Only MMA providers included in the legend below are considered providers for the purpose of meeting the MMA PSN ownership requirement pursuant to Section 409.962(13), Florida Statutes. If the answer to Column (3) is yes, complete Columns (4), (5) and (6); otherwise, leave these columns blank. If completing Column (5), preface the number with either “L” for License Number or “M” for Medicaid identification number. Add additional rows if needed. Do not modify any other formatting.

Individual PSN Owner Names

(1)

Percent of PSN Ownership

(2)

Current Medicaid Provider? (Yes/No)

(3)

Provider Type*

(4)

Provider License # or Florida

Medicaid ID Number

(5)

Tax ID (6)

*MMA Provider Type Legend (see Section 409.962(13), Florida Statutes): FP = Florida- licensed health care provider GP = group of affiliated providers PA= public agency or entity LF = Florida- licensed health care facility FQ = federally qualified health care center HH = home health care agency Respondent Name:

EXHIBIT C-6 LIST OF TERMINATED CONTRACTS


List the terminated Contracts in chronological order and provide a brief description (half-page or less) of the reason(s) for the termination. The Agency is not responsible for confirming the accuracy of the information provided. The Agency reserves the right within its sole discretion, to determine the prospective vendor to be an irresponsible bidder based on any or all of the listed Contracts and therefore may reject the prospective vendor’s response. Vendor’s Name:

Client’s Name: Term of Terminated Contract: Description of Services:

Brief Summary of Reason(s) for Contract Termination:

Vendor’s Name:

Client’s Name: Term of Terminated Contract: Description of Services:

Brief Summary of Reason(s) for Contract Termination:

There are no terminated Contracts. As the person authorized to sign, I certify that the above information is true and accurate. Respondent Name

Authorized Representative Signature Date Authorized Representative Name Authorized Representative Title

EXHIBIT C-7 VENDOR CERTIFICATION REGARDING

SCRUTINIZED COMPANIES LISTS


Respondent Vendor Name:

Vendor FEIN:

Vendor’s Authorized Representative Name and Title:

Address:

City: State: Zip:

Telephone Number:

Email Address:

Section 287.135, Florida Statutes, prohibits agencies from contracting with companies, for goods or services over $1,000,000, that are on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List. Both lists are created pursuant to Section 215.473, Florida Statutes. As the person authorized to sign on behalf of the Respondent, I hereby certify that the company identified above in the section entitled “Respondent Vendor Name” is not listed on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List. I understand that pursuant to Section 287.135, Florida Statutes, the submission of a false certification may subject company to civil penalties, attorney’s fees, and/or costs.

Certified By: ,

who is authorized to sign on behalf of the above referenced company.

Authorized Signature: _________________________________________

Print Name and Title:

EXHIBIT C-8HOME MEDICAL EQUIPMENT AND SUPPLIES PROVIDERS LIST


Provider Medicaid ID

License Number Provider Name Doing Business As Name Street_1 Street_2 City State Zip

Code County

109012701 1312221 AMERICAN HOME PATIENT 7170 N 9TH AVE PENSACOLA FL 32504 ESCAMBIA

022780301 ANDERSON'S THRIF-T DRUGS, INC. 14 WEST JORDAN STREET PENSACOLA FL 32501 ESCAMBIA

022781101 ANDERSON'S THRIF-T DRUGS, INC. MARKET PLACE 4350 BAYOU BLVD STE 5 PENSACOLA FL 32503 ESCAMBIA

950254814 HM0000674 APRIA HEALTHCARE 3636D N L ST STE B PENSACOLA FL 32505 ESCAMBIA

031884101 DURA-MED SOUTHEAST INC 174 HWY 113 FLOMATON AL 36441 ESCAMBIA

027400300 HM0000129 GILLETTE WHEELCHAIR ENGINEERS, INC 3936 NORTH DAVIS HWY PENSACOLA FL 32503 ESCAMBIA

101190101 A & E PHARMACY INC DAVID ENFINGER 923 NEW WARRINGTON RD PENSACOLA FL 32506 ESCAMBIA

25259000 283 ABLE MEDICAL & SICKROOM SUPPLIES 2475 E NINE MILES ROAD SUITE H PENSACOLA FL 32514 ESCAMBIA

32143501 AMBIENT HEALTHCARE OF WEST FLORIDA AMBIENT HEALTHCARE 213 E WRIGHT ST PENSACOLA FL 32501 ESCAMBIA

109012701 AMERICAN HOME PATIENT 7170 N 9TH AVE PENSACOLA FL 32504 ESCAMBIA

2047400 12357 BAPTIST HOSPITAL, INC BAPTIST HOME HEALTH CARE MEDICAL EQUIPMENT AND SUP

1901 N E ST PENSACOLA FL 32501 ESCAMBIA

3194800 1313544 BARNES HEATLH CARE OF FLORIDA BARNES HEALTH CARE 4081 E OLIVE RD STE L PENSACOLA FL 32514 ESCAMBIA

105463501 BIG B DRUGS, INC. CVS PHARMACY 4027 8361 N CENTURY BLVD CENTURY FL 32535 ESCAMBIA

105477501 BIG B DRUGS, INC. CVS PHARMACY 4171 1001 SCENIC HWY PENSACOLA FL 32503 ESCAMBIA

105488101 BIG B DRUGS, INC. CVS PHARMACY 4177 2100 W CERVANTES ST PENSACOLA FL 32505 ESCAMBIA

102398501 CANTONMENT PHARMACY 433 HWY. 29 SOUTH CANTONMENT FL 32533 ESCAMBIA

106614501 PH0016516 CENTURY PHARMACY 7531 MAYO STREET CENTURY FL 32535 ESCAMBIA

3410901 CORAM ALTERNATE SITE SERVICES, INC. CORAM SPECIALTY INFUSION SERVICES, AN APRIA HEALTH 3439 N 12TH AVE STE A AND B PENSACOLA FL 32503 ESCAMBIA

100993101 DRUG SHOP INC P.O. BOX 2217 PENSACOLA FL 32503 ESCAMBIA

21467101 ENSLEY PHARMACY 8814-C OLD PALAFOX STREET PENSACOLA FL 32534 ESCAMBIA

105010901 FIRESIDE PHARMACY 5507 NORTH "W" STREET PENSACOLA FL 32505 ESCAMBIA

25910100 ORF22 FITTING DESIGNS, INC 8800 UNIVERSITY PKWY SUITE B-1 PENSACOLA FL 32514 ESCAMBIA

6901600 GILG PROSTETHETICS INC GILG PROSTETHETICS INC 87 W HOOD DR PENSACOLA FL 32534 ESCAMBIA

21575900 PR0000026 GILG PROSTHETICS, INC. 87 WEST HOOD DRIVE PENSACOLA FL 32534 ESCAMBIA

27400300 HM0000129 GILLETTE WHEELCHAIR ENGINEERS,INC 3936 N. DAVIS HWY PENSACOLA FL 32503 ESCAMBIA

32522800 1313487 GRACE MEDICAL INC GRACE HEALTHCARE 3357 COPTER RD STE 1 PENSACOLA FL 32514 ESCAMBIA

26433401 GULF MEDICAL SERVICES, INC GULF MEDICAL VITAL CARE 3103 N 12TH AVE PENSACOLA FL 32503 ESCAMBIA

27405400 HM0000112 GULF MEDICAL SVC., INC. 3103 N. 12TH AVE PENSACOLA FL 32503 ESCAMBIA

951893201 HANGER PROSTHETICS & ORTHOTICS,INC 2521-C CREIGHTON RD PENSACOLA FL 32504 ESCAMBIA

2006401 PH0024579 HOLIDAY CVS L.L.C. CVS PHARMACY# 05832 1521 NW 13TH ST GAINESVILLE FL 32601 ESCAMBIA

105868101 HOLIDAY CVS, LLC CVS PHARMACY 03283 6859 N 9TH AVE PENSACOLA FL 32504 ESCAMBIA

105766901 HOLIDAY CVS, LLC CVS PHARMACY 03675 1 E NINE MILE RD PENSACOLA FL 32534 ESCAMBIA

105556901 HOLIDAY CVS, LLC CVS PHARMACY 04430 400 N NAVY BLVD PENSACOLA FL 32507 ESCAMBIA

105560701 HOLIDAY CVS, LLC CVS PHARMACY 04458 8150 N DAVIS HWY PENSACOLA FL 32514 ESCAMBIA

105561501 HOLIDAY CVS, LLC CVS PHARMACY 04461 8187 W FAIRFIELD DR DW PENSACOLA FL 32506 ESCAMBIA

106163101 HOLIDAY CVS, LLC CVS PHARMACY 05158 5301 N PALAFOX ST PENSACOLA FL 32505 ESCAMBIA





Code County

106364201 HOLIDAY CVS, LLC CVS PHARMACY 05175 13390 PERDIDO KEY DR PENSACOLA FL 32507 ESCAMBIA

106355301 HOLIDAY CVS, LLC CVS PHARMACY 05179 3880 N 9TH AVE PENSACOLA FL 32503 ESCAMBIA

106359601 HOLIDAY CVS, LLC CVS PHARMACY 05180 4500 SAUFLEY FIELD RD PENSACOLA FL 32526 ESCAMBIA

28198101 HOLIDAY CVS, LLC. 2090 S HIGHWAY 29 CANTONMENT FL 32533 ESCAMBIA

101036102 JACKSON STEVEN L JACKSON-PACE PHARMACY 2256 W NINE MILE RD PENSACOLA FL 32534 ESCAMBIA

3114001 PH25080 JOSEPH'S PHARMACY LLC 3130 N PACE BLVD PENSACOLA FL 32505 ESCAMBIA

32374801 PH0022889 JUNIOR FOOD STORES OF WEST FLORIDA, INC. KROGER PHARMACY 2990 SOUTH BLUE ANGEL PARKWAY PENSACOLA FL 32506 ESCAMBIA

101873601 K MART PHARMACY #4122 4211 MOBILE HWY PENSACOLA FL 32506 ESCAMBIA

101183901 K MART PHARMACY #4723 1650 AIRPORT BLVD. PENSACOLA FL 32504 ESCAMBIA

100724601 K MART PHARMACY #9714 NORTHVIEW SHOPPING CTR. 235 E NINE MILE RD PENSACOLA FL 32534 ESCAMBIA

31103101 KIM'S FAMILY PHARMACY, INC. 740 HIGHWAY 29 NORTH CANTONMENT FL 32533 ESCAMBIA

21728001 LANDMARK DRUGS, INC. PFEIFFERS DRUGS 2501 W CERVANTES ST PENSACOLA FL 32505 ESCAMBIA

31910400 97 LINCARE, INC 3700 CREIGHTON RD STE 9 PENSACOLA FL 32504 ESCAMBIA

950809100 HM0000094 M*A*S*H* INC 5800 NORTH W STREET 5 PENSACOLA FL 32505 ESCAMBIA

302200 1313455 MEDICAL SERVICES OF AMERICA INC MEDI HOME CARE 2411 EXECUTIVE PLAZA RD PENSACOLA FL 32504 ESCAMBIA

2932000 ORT000017 PENSACOLA ORTHOTIC & PROSTHETIC SPECIALTIES, INC

PENSACOLA ORTHOTIC & PROSTHETIC SPECIALTIES, INC

5855 CREEK STATION DR PENSACOLA FL 32504 ESCAMBIA

2681100 POR145 PERFORMANCE PROSTHETICS & ORTHOTICS 2280 N 9TH AVE PENSACOLA FL 32503 ESCAMBIA

783001 PUBLIX SUPER MARKETS, INC PUBLIX PHARMACY #1343 2180 W NINE MILE RD PENSACOLA FL 32534 ESCAMBIA

1885501 PH0024293 PUBLIX SUPER MARKETS, INC PUBLIX PHARMACY #1316 5055 N 9TH AVE PENSACOLA FL 32504 ESCAMBIA

2670001 PH0024774 PUBLIX SUPER MARKETS, INC. PUBLIX PHARMACY #1296 13390 PERDIDO KEY DRIVE PENSACOLA FL 32507 ESCAMBIA

1742301 PUBLIX SUPER MARKETS, INC. PUBLIX PHARMACY #1318 5998 MOBILE HWY PENSACOLA FL 32526 ESCAMBIA

664701 PH0023622 PUBLIX SUPER MARKETS, INC. PUBLIX PHARMACY 1317 9251 UNIVERSITY PKWY PENSACOLA FL 32514 ESCAMBIA

32608900 1313395 RESPIRATORY CONSULTANTS, INC 450 VAN PELT LANE PENSACOLA FL 32505 ESCAMBIA

21659300 HM0000337 ROTECH OXYGEN & MED EQUIPMENT, INC PFEIFFER MEDICAL EQUIPMENT 1211 CREIGHTON RD PENSACOLA FL 32504 ESCAMBIA

21966501 RX ADVANTAGE, INC. 2256-B WEST NINE MILE ROAD PENSACOLA FL 32534 ESCAMBIA

103353101 PH0009498 SACRED HEART HOSPITAL OF PENSACOLA SUITE 205 5149 N 9TH AVE PENSACOLA FL 32504 ESCAMBIA

25451701 SAM'S EAST INC SAM'S PHARMACY 10-8119 1250 AIRPORT BLVD PENSACOLA FL 32504 ESCAMBIA

22416201 PH0017514 SCOTT'S PHARMACY 6505 HWY 29 NORTH MOLINO FL 32577 ESCAMBIA

851001 TARGET CORPORATION TARGET STORE T-2445 2950 S BLUE ANGEL PKWY PENSACOLA FL 32506 ESCAMBIA

101363701 TARGET CORPORATION TARGET STORE T-0686 4711 BAYOU BLVD PENSACOLA FL 32503 ESCAMBIA

22245301 TARGET CORPORATION TARGET STORE T-1273 1749 E NINE MILE RD PENSACOLA FL 32514 ESCAMBIA

104267001 THE TOWERS PHARMACY, INC. 1717 N "E" ST SUITE 102 PENSACOLA FL 32501 ESCAMBIA

22025601 TWIN TOWERS PHARMACY BAPTIST MEDICAL PARK PHRMCY 9400 UNIVERSITY PKWY PENSACOLA FL 32514 ESCAMBIA

26410500 VERHI, INC GULF COAST ORTHOTICS & PROST 824 CREIGHTON RD PENSACOLA FL 32504 ESCAMBIA

587701 PH0023750 WALGREEN CO WALGREENS 13072 8333 N DAVIS HWY STE 50 PENSACOLA FL 32514 ESCAMBIA

28310001 PH0021041 WALGREEN CO WALGREEN 01222 20 W NINE MILE RD PENSACOLA FL 32534 ESCAMBIA

22980601 WALGREEN CO WALGREEN 05659 870 E CERVANTES ST PENSACOLA FL 32501 ESCAMBIA

26224201 WALGREEN CO WALGREEN 07344 700 N PACE BLVD PENSACOLA FL 32505 ESCAMBIA





Code County

26914001 WALGREEN CO WALGREEN 07650 1909 E NINE MILE RD PENSACOLA FL 32514 ESCAMBIA

31643101 WALGREEN CO WALGREENS 09916 1841 E OLIVE RD PENSACOLA FL 32514 ESCAMBIA

31991101 WALGREEN CO WALGREENS 09917 5995 MOBILE HWY PENSACOLA FL 32526 ESCAMBIA

31948101 WALGREEN CO WALGREENS 10181 2237 W NINE MILE RD PENSACOLA FL 32534 ESCAMBIA

32074901 WALGREEN CO WALGREENS 10312 85 BEVERLY PKWY PENSACOLA FL 32505 ESCAMBIA

32587201 WALGREEN CO. WALGREENS 01042 4497 MOBILE HWY PENSACOLA FL 32506 ESCAMBIA

22295001 WALGREEN CORPORATION WALGREEN 05581 6314 N 9TH AVE PENSACOLA FL 32504 ESCAMBIA

100415801 WAL-MART #10-1222 8970 PENSACOLA BLVD. PENSACOLA FL 32514 ESCAMBIA

109977901 WAL-MART #10-1224 2650 CREIGHTON RD. PENSACOLA FL 32504 ESCAMBIA

101027101 WAL-MART PHARMACY 10-1605 4600 MOBILE HWY. SUITE 122 PENSACOLA FL 32506 ESCAMBIA

25449501 WAL-MART STORES EAST LP WAL-MART PHARMACY 10-3484 2951 S BLUE ANGEL PKWY PENSACOLA FL 32506 ESCAMBIA

31786101 WAL-MART STORES EAST, LP WAL-MART PHARMACY 10-3785 501 N NAVY BLVD PENSACOLA FL 32507 ESCAMBIA

26484901 WINN DIXIE MONTGOMERY, INC WINN DIXIE PHARMACY 493 13019 SORRENTO RD PENSACOLA FL 32507 ESCAMBIA

25617001 WINN DIXIE PHARMACY #504 WINN DIXIE MONTGOMERY, INC 7135 N 9TH AVE PENSACOLA FL 32504 ESCAMBIA

101249501 WINN DIXIE PHARMACY 556 4751 BAYOU BLVD. PENSACOLA FL 32503 ESCAMBIA

106536001 WINN-DIXIE #535 WINN-DIXIE INC 50 S BLUE ANGEL PKWY PENSACOLA FL 32506 ESCAMBIA

220007401 WINN-DIXIE MONTGOMERY, INC. WINN-DIXIE PHARMACY 506 312 E NINE MILE RD PENSACOLA FL 32514 ESCAMBIA

106281601 WINN-DIXIE PHARMACY #2244 WINN-DIXIE STORES INC. 111 FLAGLER PLAZA DR PALM COAST FL 32137 ESCAMBIA

106600501 WINN-DIXIE PHARMACY #495 5975 MOBILE HWY PENSACOLA FL 32526 ESCAMBIA

97 ADULT AND PEDIATRIC SPECIALISTS 3700 CREIGHTON RD STE 9 PENSACOLA FL 32504 ESCAMBIA

1312221 AMERICAN HOMEPATIENT 7170 N 9TH AVE PENSACOLA FL 32504 ESCAMBIA

1313300 B & B MEDICAL SERVICES INC 3899 NORTH W STE 43 PENSACOLA FL 32505 ESCAMBIA

1313544 BARNES HEALTHCARE OF FLORIDA LLC 124 INDUSTRIAL BLVD PENSACOLA FL 32505 ESCAMBIA

112 GULF MEDICAL SERVICES INC 3103 N 12TH AVENUE PENSACOLA FL 32503 ESCAMBIA

1312983 HYGEIA MEDICAL EQUIPMENT LLC 2 N PALAFOX ST STE 201 PENSACOLA FL 32502 ESCAMBIA

1313427 KCI USA INC 9900 F N PALAFOX ST PENSACOLA FL 32534 ESCAMBIA

1313529 LIFEGAS 3179 GATEWAY LN CANTONMENT FL 32533 ESCAMBIA

1313455 MEDI HOME CARE 2411 EXECUTIVE PLAZA RD PENSACOLA FL 32504 ESCAMBIA

337 PFEIFFER MEDICAL EQUIPMENT 1211 CREIGHTON RD PENSACOLA FL 32504 ESCAMBIA

283 SWEETWATER MEDICAL WEST 2475 E NINE MILE RD STE H PENSACOLA FL 32514 ESCAMBIA

030829309 BARNES HEALTHCARE OF FLORIDA LLC 2207 S. FREEDOM BLVD CRESTVIEW FL 32530 OKALOOSA

002027600 1312932 BARNES HEALTHCARE OF FLORIDA, LLC BARNES HEALTHCARE 2207 S. FERDON BLVD CRESTVIEW FL 32539 OKALOOSA

028315100 1593 GULF MEDICAL SERVICES INC 320 RACETRACK RD NE FT WALTON BEACH FL 32547 OKALOOSA

27468200 1312665 AMERICAN HOME PATIENT 115 F RACETRACK RD NW FT. WALTON BEACH FL 32547 OKALOOSA

105474101 BIG B DRUGS, INC. CVS PHARMACY 4015 302 E JAMES LEE BLVD CRESTVIEW FL 32539 OKALOOSA

32149400 OR00000156 CREATIVE ORTHOTIC & PROSTHETIC SER 120 E REDSTONE AVE STE C CRESTVIEW FL 32539 OKALOOSA

25327801 CRESTVIEW PHARMACY INC. 1116 N. FERDON BLVD. CRESTVIEW FL 32536 OKALOOSA

105801101 CVS EGL 13TH SAINT CLOUD FL, L.L.C. CVS PHARMACY 03139 3441 13TH ST SAINT CLOUD FL 34769 OKALOOSA

105219501 GARRETT'S PHARMACY SERVICES, INC THE PRESCRIPTION SHOPPE 536 E 1ST AVE CRESTVIEW FL 32536 OKALOOSA

951893202 HANGER PROSTHETICS & ORTHOTICS,INC FORT WALTON ORTHOPEDIC, INC 28 PERRY AVE SE FORT WALTON BEACH FL 32548 OKALOOSA





Code County

102978901 HEALTH-SMART PHARMACY 5809 HIGHWAY 189 NORTH BAKER FL 32531 OKALOOSA

21527901 HOLIDAY CVS, LLC CVS PHARMACY 05194 1081 BEAL PKWY NW FORT WALTON BEACH FL 32547 OKALOOSA

105558501 HOLIDAY CVS, LLC CVS PHARMACY 04440 434 RACETRACK RD NE FT WALTON BCH FL 32547 OKALOOSA

30807201 HOLIDAY CVS, LLC 60 SOUTH HOLIDAY ROAD MIRAMAC FL 32550 OKALOOSA

106280801 HOLIDAY CVS, LLC CVS PHARMACY 04612 4562 E HIGHWAY 20 NICEVILLE FL 32578 OKALOOSA

106248401 HOLIDAY CVS, LLC. CVS PHARMACY 03003 71 MARY ESTHER BLVD MARY ESTHER FL 32569 OKALOOSA

104436201 K MART PHARMACY #3223 200 IRWIN AVE NE FT WALTON BCH FL 32548 OKALOOSA

25919500 HM0001229 LINCARE 430 BRYN ATHYN BLVD STE 2 MARY ESTHER FL 32569 OKALOOSA

3047200 1313384 LINCARE INC HCS HEALTH CARE SOLUTIONS 802 CCS ST FT WALTON BCH FL 32547 OKALOOSA

27450000 96 M.A.S.H. INC. 242 RACETRACK RD N.E. FT. WALTON BEACH FL 32547 OKALOOSA

27707000 HME93 M.A.S.H.,INC. 1505-B SOUTH FERDON BLVD CRESTVIEW FL 32536 OKALOOSA

103146501 MOULTONS PHARMACY 648 NORTH FERDON BLVD CRESTVIEW FL 32536 OKALOOSA

2345100 NATIONAL REHAB EQUIPMENT,INC 11 RACETRACK RD NE FORT WALTON BEACH FL 32547 OKALOOSA

26601901 PUBLIX SUPER MARKETS INC PUBLIX PHARMACY 0383 421 MARY ESTHER CUT OFF NW FORT WALTON BEACH FL 32548 OKALOOSA

789801 PH0023723 PUBLIX SUPER MARKETS, INC PUBLIX PHARMACY #1303 610 EGLIN PKWY NE FORT WALTON BEACH FL 32547 OKALOOSA

25156901 PUBLIX SUPER MARKETS, INC. PUBLIX PHARMACY 0801 2250 S FERDON BLVD CRESTVIEW FL 32536 OKALOOSA

22825701 PUBLIX SUPER MARKETS, INC. PUBLIX PHARMACY 0766 251 MIRACLE STRIP PKWY SE FORT WALTON BEACH FL 32548 OKALOOSA

21834101 PUBLIX SUPERMARKETS, INC. PUBLIX PHARMACY 7677 4425 COMMONS DR E DESTIN FL 32541 OKALOOSA

26813501 SAMS EAST INC SAMS PHARMACY 10-6361 740 BEAL PKWY NW FORT WALTON BEACH FL 32547 OKALOOSA

31080801 TARGET CORPORATION TARGET STORE T-2085 853 HARBOR BLVD DESTIN FL 32541 OKALOOSA

103370101 TARGET CORPORATION TARGET STORE T-0740 650 MIRACLE STRIP PKWY MARY ESTHER FL 32569 OKALOOSA

25437101 WALGREEN CO WALGREEN 06811 2350 S FERDON BLVD CRESTVIEW FL 32536 OKALOOSA

25473801 WALGREEN CO WALGREEN 06578 977 HIGHWAY 98 E DESTIN FL 32541 OKALOOSA

22265801 WALGREEN CO WALGREEN 05582 825 BEAL PKWY NW FORT WALTON BEACH FL 32547 OKALOOSA

25600501 WALGREEN CO WALGREEN 06978 4582 E HIGHWAY 20 NICEVILLE FL 32578 OKALOOSA

106602101 PH0016383 WALGREEN CO. #4848 414 C MARY ESTHER CUTOFF NW FT. WALTON BCH FL 32548 OKALOOSA

106572601 PH0016368 WALGREEN CO.#04913 34909 EMERALD COAST PKWY DESTIN FL 32541 OKALOOSA

101769101 PH0009372 WAL-MART #10-0919 546 MARY ESTER CUTOFF FT. WALTON BEACH FL 32548 OKALOOSA

109366501 PH0009380 WAL-MART #10-0944 PHARMACY MANAGER 3351 S FERDON BLVD CRESTVIEW FL 32536 OKALOOSA

100824201 WAL-MART PHARMACY #10-1362 EMERALD COAST CENTER 15003 EMERALD COAST PKWY DESTIN FL 32541 OKALOOSA

3180501 WAL-MART STORES EAST, LP WAL-MART PHARMACY 10-5848 1300 JOHN SIMS PKWY E NICEVILLE FL 32578 OKALOOSA

102784101 WINN DIXIE PHARMACY #541 798 BEAL PARKWAY FT WALTON BEACH FL 32547 OKALOOSA

101420001 PH11981 WINN DIXIE PHARMACY #551 4512 E HIGHWAY 20 NICEVILLE FL 32578 OKALOOSA

106270101 WINN-DIXIE #566 WINN-DIXIE INC. 99 EGLIN PKWY FORT WALTON BEACH FL 32548 OKALOOSA

106396101 WINN-DIXIE INC WINN-DIXIE 558 1326 N FERDON BLVD CRESTVIEW FL 32536 OKALOOSA

21941001 WINN-DIXIE MONTGOMERY, INC. WINN DIXIE PHARMACY 560 981 U.S. HIGHWAY 98 DESTIN FL 32541 OKALOOSA

1313194 AMERICAN HOMEPATIENT 115 F RACETRACK RD NW FORT WALTON BEACH FL 32547 OKALOOSA

1313384 HCS HEALTH CARE SOLUTIONS 107 BAILEY DR NICEVILLE FL 32578 OKALOOSA





Code County

1604 J & B MEDICAL INC 540 E JOHN SIMS PKWY NICEVILLE FL 32578 OKALOOSA

1313836 MEDI HOME CARE 1982-D LEWIS TURNER BLVD STE 101 FORT WALTON BEACH FL 32547 OKALOOSA

1313709 RESPIRATORY SERVICES OF NORTHWEST FLORIDA INC 502 E PINE AVE STE B CRESTVIEW FL 32539 OKALOOSA

1313083 SLEEPMED THERAPY SERVICES 907 MAR WALT DR STE 2022 FORT WALTON BEACH FL 32547 OKALOOSA

951087700 HM0000040 DURA-MED SOUTHEAST, INC. 5272 COMMERCE ST JAY FL 32565 SANTA ROSA

030877300 1312572 TRI-CITY HOME MEDICAL INC 3878 HIGHWAY 4 JAY FL 32565 SANTA ROSA

3512400 1312459 AABON HOME HEALTH CARE SUPPLY, INC 5201 DOGWOOD DR MILTON FL 32570 SANTA ROSA

105470801 BIG B DRUGS, INC. CVS PHARAMCY 4155 3359 GULF BREEZE PKWY GULF BREEZE FL 32563 SANTA ROSA

106315401 BURKLOW PHARMACY 4880 WOODBINE ROAD PACE FL 32571 SANTA ROSA

106357001 HOLIDAY CVS, LLC CVS PHARMACY 05176 713 GULF BREEZE PKWY GULF BREEZE FL 32561 SANTA ROSA

105559301 HOLIDAY CVS, LLC CVS PHARMACY 04449 6501 CAROLINE ST MILTON FL 32570 SANTA ROSA

106494101 HOLIDAY CVS, LLC CVS PHARMACY 05248 8422 NAVARRE PKWY NAVARRE FL 32566 SANTA ROSA

106358801 HOLIDAY CVS, LLC CVS PHARMACY 05178 1100 JOHN SIMS PKWY E NICEVILLE FL 32578 SANTA ROSA

106241701 HOLIDAY CVS, LLC CVS PHARMACY 05249 3888 HIGHWAY 90 PACE FL 32571 SANTA ROSA

101481102 JAY PHARMACY INC 200 COMMERCE ST JAY FL 32565 SANTA ROSA

102675501 K MART PHARMACY # 3975 KMART CORPORATION 6050 HIGHWAY 90 MILTON FL 32570 SANTA ROSA

27740101 HM0001230 LINCARE INC-PENSACOLA 5700 N DAVIS HWY/ 6 PENSACOLA FL 32503 SANTA ROSA

26654001 MCGAW RX, INC THE MEDICINE SHOPPE 5524 STEWART ST MILTON FL 32570 SANTA ROSA

26836401 PARK AVENUE PHARMACY INC 5440 DOGWOOD DR MILTON FL 32570 SANTA ROSA

32617801 PUBLIX SUPER MARKETS, INC PUBLIX PHARMACY 1189 852 GULF BREEZE PKWY GULF BREEZE FL 32561 SANTA ROSA

731801 PH23686 PUBLIX SUPER MARKETS, INC PUBLIX PHARMACY #1313 2381 W STATE ROAD 434 LONGWOOD FL 32779 SANTA ROSA

26377001 PUBLIX SUPER MARKETS, INC PUBLIX PHARMACY 0896 8244 NAVARRE PKWY NAVARRE FL 32566 SANTA ROSA

361201 PUBLIX SUPER MARKETS, INC PUBLIX PHARMACY #1225 4739 HIGHWAY 90 PACE FL 32571 SANTA ROSA

4633601 RX EXPRESS PHARMACY OF MILTON, INC. RX EXPRESS PHARMACY 5941 BERRYHILL RD STE H MILTON FL 32570 SANTA ROSA

25532701 RX EXPRESS PHARMACY OF NAVARRE INC RX EXPRESS PHARMACY 1931 ORTEGA ST NAVARRE FL 32566 SANTA ROSA

30875700 1312188 SPECIALISTS OF ENTERPRISE, INC. 4964 HIGHWAY 90 STE B PACE FL 32571 SANTA ROSA

32160501 TARGET CORPORATION TARGET STORE T-2279 4727 HIGHWAY 90 PACE FL 32571 SANTA ROSA

25757501 WALGREEN #06210 WALGREEN CO 1459 TIGER PARK LN GULF BREEZE FL 32563 SANTA ROSA

1534401 WALGREEN CO WALGREENS 12300 6506 CAROLINE ST MILTON FL 32570 SANTA ROSA

31090501 WALGREEN CO WALGREEN 09535 8220 NAVARRE PKWY NAVARRE FL 32566 SANTA ROSA

22547901 WALGREEN CO. WALGREEN 05757 3909 HIGHWAY 90 PACE FL 32571 SANTA ROSA

109514501 PH0009483 WAL-MART #10-0990 PHARMACY MANAGER 4965 HIGHWAY 90 MILTON FL 32571 SANTA ROSA

106332401 WAL-MART PHARMACY #10-2533 WAL-MART STORES EAST,INC. 3767 GULF BREEZE PKWY GULF BREEZE FL 32563 SANTA ROSA

4776401 WAL-MART STORES EAST, LP WAL-MART PHARMACY 10-5623 334 GULF BREEZE PKWY GULF BREEZE FL 32561 SANTA ROSA

31888401 WAL-MART STORES EAST, LP WAL-MART PHARMACY 10-3439 9360 NAVARRE PKWY NAVARRE FL 32566 SANTA ROSA

100446802 WINKLES' PHARMACY 3818 HWY 90 EAST PACE FL 32571 SANTA ROSA

114 GULF MEDICAL SERVICES INC 6776 CAROLINE ST MILTON FL 32570 SANTA ROSA

1313672 HOVEROUND CORPORATION 5680 GULF BREEZE PKWY D6 GULF BREEZE FL 32563 SANTA ROSA

1312188 RESPIRATORY SPECIALIST 4964 HWY 90 STE B PACE FL 32571 SANTA ROSA





Code County

672311096 MASH INC 379 E NELSON AVE DEFUNIAK SPRINGS FL 32433 WALTON

104725601 FISHER PHCY 688 BALDWIN AVENUE DEFUNIAK SPRGS FL 32433 WALTON

4329200 4234 HEALTHMARK OF WALTON, INC. HEALTHMARK HOME HEALTH AGENCY 4413 US HIGHWAY 331 S DEFUNIAK SPRINGS FL 32435 WALTON

105773101 HOLIDAY CVS, LLC CVS PHARMACY 03684 35 POINCIANA BLVD DESTIN FL 32550 WALTON

201611700 95 M.A.S.H. INC. 379 EAST NELSON AVENUE DEFUNIAK SPRINGS FL 32433 WALTON

31129401 PRESCRIPTION PLACE DEFUNIAK SPRINGS THE PRESCRIPTION PLACE 1337 US HIGHWAY 90 W DEFUNIAK SPRINGS FL 32433 WALTON

26508001 PUBLIX SUPER MARKETS, INC PUBLIX PHARMACY 0885 725 GRAND BLVD SANDESTIN FL 32550 WALTON

1771801 PUBLIX SUPER MARKETS, INC. PUBLIX PHARMACY #1258 2038 US HIGHWAY 98 W SANTA ROSA BEACH FL 32459 WALTON

3789301 PH25428 SOUTH WALTON PHARMACY, LLC SANTA ROSA PHARMACY 19 TOWN CENTER LOOP UNIT 1A SANTA ROSA BEACH FL 32459 WALTON

31927901 WALGREEN CO WALGREENS 09914 1103 US HIGHWAY 331 S DEFUNIAK SPRINGS FL 32435 WALTON

109866701 WAL-MART #10-1134 1226 FREEPORT ROAD DEFUNIAK SPRINGS FL 32433 WALTON

3651801 WAL-MART STORES EAST, LP WAL-MART PHARMACY 10-5872 6712 US HIGHWAY 98 W SANTA ROSA BEACH FL 32459 WALTON

104210601 WEEKS PHARMACY 132 EAST HWY. 20 FREEPORT FL 32439 WALTON

103115501 WINN-DIXIE #577 WINN-DIXIE MTG INC. 103G US HIGHWAY 331 S DEFUNIAK SPRINGS FL 32435 WALTON

EXHIBIT C-9 REGION 1 REGIONAL PREFERENCE HIERARCHY


Respondent’s Name:

The Agency shall award an additional Region to each vendor who responds to the Region 1 ITN and receives a Contract award. The Agency shall award the additional Region in any other Region in which the vendor submits a responsive reply and negotiates a rate acceptable to the Agency. That additional Region shall be awarded to the vendor's top choice, as listed below in the Regional Preference Hierarchy Table, provided the vendor submits a responsive reply and negotiates a rate acceptable to the Agency. In no instance shall the statutory maximum be exceeded. If it has, the Agency shall make the additional award in the next available Region listed in the Respondent’s Regional Preference Hierarchy Table, below. If the vendor has already been chosen through the negotiation process in its top choice as listed below, then it will be awarded its next choice provided it submitted a responsive reply and negotiates a rate acceptable to the Agency.

Respondents shall complete the Regional Preference Hierarchy Table below, to indicate its preference for receipt of additional Contract awards. If the Regional Preference Hierarchy Table is left blank, the vendor indicates that it does not desire any additional Region awards. Respondents shall indicate the region(s) in hierarchy order (highest desire being 1 and lowest desire being 10).

REGIONAL PREFERENCE HIEARCHY

Order Requested for Additional Award By Region

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Name of Respondent Name and Title of Respondent Representative

EXHIBIT C-10 CERTIFICATION OF DRUG-FREE WORKPLACE PROGRAM


In the event of Identical or Tie Bids/Proposals: Preference shall be given to businesses with drug-free workplace programs. Whenever two or more bids which are equal with respect to price, quality, and service are received by the State or by any political subdivision for the procurement of commodities or contractual services, a bid received from a business that certifies that it has implemented a drug-free work place program shall be given preference in the award process. Established procedures for processing tied awards will be followed if none of the tied vendors have a drug-free workplace program. In order to have a drug-free workplace program, a business shall:

1) Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition.

2) Inform employees about the dangers of drug abuse in the workplace, the business’s

policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations.

3) Give each employee engaged in providing the commodities or contractual services

that are under bid a copy of the statement specified in subsection (1). 4) In the statement specified in subsection (1), notify the employees that, as a condition

of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of chapter 893 or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction.

5) Impose a sanction on, or require the satisfactory participation in a drug abuse

assistance or rehabilitation program if such is available in the employee’s community by, any employee who is so convicted.

6) Make a good faith effort to continue to maintain a drug-free workplace through

implementation of this section. As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements. _________________________________________ Signature Date

Printed Name of Signer/ Title of Signer/ Company Name

EXHIBIT C-11 STANDARD CONTRACT

AHCA ITN 017-12/13, Exhibit C-11, Page 1 of 19 AHCA Form 2100-0007 (Rev. OCT 12)

All prospective vendors should review the proposed contract language contained below. In responding to this AHCA solicitation, a prospective vendor has agreed to accept the terms and conditions of the contract contained in this attachment. The Agency reserves the right to make modifications to this contract if it is deemed to be in the best interest of the Agency or the State of Florida. Note: If this contract is funded with federal funds, additional terms and conditions may be included at the time of contract award based on the specific federal requirements

Contract No.

STATE OF FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION

STANDARD CONTRACT

THIS CONTRACT is entered into between the State of Florida, AGENCY FOR HEALTH CARE ADMINISTRATION, hereinafter referred to as the "Agency", whose address is 2727 Mahan Drive, Tallahassee, Florida 32308, and hereinafter referred to as the "Vendor", whose address is , a (type of entity), to provide . I. THE VENDOR HEREBY AGREES:

A. General Provisions

1. To provide services according to the terms and conditions set forth in this Contract, Attachment I, Scope of Services, and all other attachments named herein which are attached hereto and incorporated by reference (collectively referred to herein as the “Contract”).

2. To perform as an independent vendor and not as an agent,

representative, or employee of the Agency. 3. To recognize that the State of Florida, by virtue of its sovereignty, is not

required to pay any taxes on the services or goods purchased under the terms of this Contract.

B. Federal Laws and Regulations

1. This Contract contains federal funds, therefore, the Vendor shall comply

with the provisions of 45 CFR, Part 74, and/or 45 CFR, Part 92, and other applicable regulations.

2. This Contract contains federal funding in excess of $100,000, therefore,

the Vendor must, upon Contract execution, complete the Certification Regarding Lobbying form, Attachment III. If a Disclosure of Lobbying Activities form, Standard Form LLL, is required, it may be obtained from the Agency’s Contract Manager. All disclosure forms as required by the Certification Regarding Lobbying form must be completed and returned to the Agency’s Procurement Office.

3. Pursuant to 45 CFR, Part 76, the Vendor must, upon Contract execution,

complete the Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion Contracts/Subcontracts, Attachment IV.



C. Audits and Records

1. To maintain books, records, and documents (including electronic storage media) pertinent to performance under this Contract in accordance with generally accepted accounting procedures and practices which sufficiently and properly reflect all revenues and expenditures of funds provided by the Agency under this Contract.

2. To assure that these records shall be subject at all reasonable times to

inspection, review, or audit by state personnel and other personnel duly authorized by the Agency, as well as by federal personnel.

3. To maintain and file with the Agency such progress, fiscal and inventory

reports as specified in Attachment I, Scope of Services, and other reports as the Agency may require within the period of this Contract. In addition, access to relevant computer data and applications which generated such reports should be made available upon request. “Include” for Vendor relationships.

4. To ensure that all related party transactions are disclosed to the Agency Contract Manager. “Delete” unless a Recipient relationship.

5. To provide a financial and compliance audit to the Agency as specified in Attachment ____ and to ensure that all related party transactions are disclosed to the Agency Contract Manager. Additional audit requirements are specified in Attachment I, Scope of Services, Section ___.

6. To include these aforementioned audit and record keeping requirements in all approved subcontracts and assignments.

D. Retention of Records

1. To retain all financial records, supporting documents, statistical records, and any other documents (including electronic storage media) pertinent to performance under this Contract for a period of six (6) years after termination of this Contract, or if an audit has been initiated and audit findings have not been resolved at the end of six (6) years, the records shall be retained until resolution of the audit findings.

2. Persons duly authorized by the Agency and federal auditors, pursuant to

45 CFR, Part 74 and/or 45 CFR, Part 92, shall have full access to and the right to examine any of said records and documents.

3. The rights of access in this section must not be limited to the required

retention period but shall last as long as the records are retained. E. Monitoring

1. To provide reports as specified in Attachment I, Scope of Services. These reports will be used for monitoring progress or performance of the contractual services as specified in Attachment I, Scope of Services.



2. To permit persons duly authorized by the Agency to inspect any records, papers, documents, facilities, goods and services of the Vendor which are relevant to this Contract.

F. Indemnification

The Vendor shall save and hold harmless and indemnify the State of Florida and the Agency against any and all liability, claims, suits, judgments, damages or costs of whatsoever kind and nature resulting from the use, service, operation or performance of work under the terms of this Contract, resulting from any act, or failure to act, by the Vendor, its subcontractor, or any of the employees, agents or representatives of the Vendor or subcontractor.

G. Insurance

1. To the extent required by law, the Vendor will be self-insured against, or will secure and maintain during the life of this Contract, Workers’ Compensation Insurance for all its employees connected with the work of this project and, in case any work is subcontracted, the Vendor shall require the subcontractor similarly to provide Workers’ Compensation Insurance for all of the latter’s employees unless such employees engaged in work under this Contract are covered by the Vendor’s self insurance program. Such self insurance or insurance coverage shall comply with the Florida Workers’ Compensation law. In the event hazardous work is being performed by the Vendor under this Contract and any class of employees performing the hazardous work is not protected under Workers’ Compensation statutes, the Vendor shall provide, and cause each subcontractor to provide, adequate insurance satisfactory to the Agency, for the protection of its employees not otherwise protected.

2. The Vendor shall secure and maintain Commercial General Liability

insurance including bodily injury, property damage, personal & advertising injury and products and completed operations. This insurance will provide coverage for all claims that may arise from the services and/or operations completed under this Contract, whether such services and/or operations are by the Vendor or anyone directly employed by it. Such insurance shall include the State of Florida as an Additional Named Insured for the entire length of the Contract and hold the State of Florida harmless from subrogation. The Vendor shall set the limits of liability necessary to provide reasonable financial protections to the Vendor and the State of Florida under this Contract.

3. All insurance policies shall be with insurers licensed or eligible to transact

business in the State of Florida. The Vendor’s current insurance policy(ies) shall contain a provision that the insurance will not be canceled for any reason except after thirty (30) days written notice. The Vendor shall provide thirty (30) day written notice of cancellation to the Agency’s Contract Manager.

H. Assignments and Subcontracts

To neither assign the responsibility of this Contract to another party nor subcontract for any of the work contemplated under this Contract without prior written approval of the Agency. No such approval by the Agency of any



assignment or subcontract shall be deemed in any event or in any manner to provide for the incurrence of any obligation of the Agency in addition to the total dollar amount agreed upon in this Contract. All such assignments or subcontracts shall be subject to the conditions of this Contract and to any conditions of approval that the Agency shall deem necessary.

I. Return of Funds To return to the Agency any overpayments due to unearned funds or funds

disallowed pursuant to the terms of this Contract that were disbursed to the Vendor by the Agency. The Vendor shall return any overpayment to the Agency within forty (40) calendar days after either discovery by the Vendor, its independent auditor, or notification by the Agency, of the overpayment.

J. Purchasing

1. P.R.I.D.E.

It is expressly understood and agreed that any articles which are the subject of, or required to carry out this Contract shall be purchased from the corporation identified under Chapter 946, Florida Statutes, if available, in the same manner and under the same procedures set forth in Section 946.515(2), and (4), Florida Statutes; and, for purposes of this Contract, the person, firm or other business entity carrying out the provisions of this Contract shall be deemed to be substituted for this Agency insofar as dealings with such corporation are concerned.

The “Corporation identified” is PRISON REHABILITATIVE INDUSTRIES AND DIVERSIFIED ENTERPRISES, INC. (P.R.I.D.E.) which may be contacted at:

P.R.I.D.E. 12425 28th Street North, Suite 300 St. Petersburg, FL 33716 E-Mail: [email protected] (727) 556-3300 Toll Free: 1-800-643-8459 Fax: (727) 570-3366

2. RESPECT of Florida

It is expressly understood and agreed that any articles that are the subject of, or required to carry out, this Contract shall be purchased from a nonprofit agency for the blind or for the severely handicapped that is qualified pursuant to Chapter 413, Florida Statutes, in the same manner and under the same procedures set forth in Section 413.036(1) and (2), Florida Statutes; and, for purposes of this Contract, the person, firm, or other business entity carrying out the provisions of this Contract shall be deemed to be substituted for this Agency insofar as dealings with such qualified nonprofit agency are concerned.

The "nonprofit agency” identified is RESPECT of Florida which may be

contacted at: RESPECT of Florida




2475 Apalachee Parkway, Suite 205 Tallahassee, Florida 32301-4946 (850) 487-1471 Website: www.respectofflorida.org

3. Procurement of Products or Materials with Recycled Content

It is expressly understood and agreed that any products which are required to carry out this Contract shall be procured in accordance with the provisions of Section 403.7065, Florida Statutes.

K. Civil Rights Requirements/Vendor Assurance

The Vendor assures that it will comply with:

1. Title VI of the Civil Rights Act of 1964, as amended, 42 U.S.C. 2000d et

seq., which prohibits discrimination on the basis of race, color, or national origin.

2. Section 504 of the Rehabilitation Act of 1973, as amended, 29 U.S.C. 794, which prohibits discrimination on the basis of handicap.

3. Title IX of the Education Amendments of 1972, as amended, 20 U.S.C. 1681 et seq., which prohibits discrimination on the basis of sex.

4. The Age Discrimination Act of 1975, as amended, 42 U.S.C. 6101 et seq., which prohibits discrimination on the basis of age.

5. Section 654 of the Omnibus Budget Reconciliation Act of 1981, as amended, 42 U.S.C. 9849, which prohibits discrimination on the basis of race, creed, color, national origin, sex, handicap, political affiliation or beliefs.

6. The Americans with Disabilities Act of 1990, P.L. 101-336, which prohibits discrimination on the basis of disability and requires reasonable accommodation for persons with disabilities.

7. All regulations, guidelines, and standards as are now or may be lawfully adopted under the above statutes.

The Vendor agrees that compliance with this assurance constitutes a condition of continued receipt of or benefit from funds provided through this Contract, and that it is binding upon the Vendor, its successors, transferees, and assignees for the period during which services are provided. The Vendor further assures that all contractors, subcontractors, subgrantees, or others with whom it arranges to provide services or benefits to participants or employees in connection with any of its programs and activities are not discriminating against those participants or employees in violation of the above statutes, regulations, guidelines, and standards.

L. Discrimination

An entity or affiliate who has been placed on the discriminatory vendor list may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work; may not submit bids, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity; and may not transact business with any public entity. The Florida Department of Management Services is responsible for maintaining




the discriminatory vendor list and intends to post the list on its website. Questions regarding the discriminatory vendor list may be directed to the Florida Department of Management Services, Office of Supplier Diversity at (850) 487-0915.

M. Requirements of Section 287.058, Florida Statutes

1. To submit bills for fees or other compensation for services or expenses in

detail sufficient for a proper pre-audit and post-audit thereof.

2. Where applicable, to submit bills for any travel expenses in accordance with Section 112.061, Florida Statutes. The Agency may establish rates lower than the maximum provided in Section 112.061, Florida Statutes.

3. To provide units of deliverables, including reports, findings, and drafts, in

writing and/or in an electronic format agreeable to both parties, as specified in Attachment I, Scope of Services, to be received and accepted by the Contract Manager prior to payment.

4. To comply with the criteria and final date, as specified herein, by which

such criteria must be met for completion of this Contract.

This Contract shall begin upon execution by both parties or , (whichever is later) and end on , inclusive.

In accordance with Section 287.057(13), Florida Statutes, this Contract may be renewed for a period that may not exceed three (3) years or the term of the original Contract, whichever period is longer. Renewal of the Contract shall be in writing and subject to the same terms and conditions set forth in the initial contract. A renewal Contract may not include any compensation for costs associated with the renewal. Renewals are contingent upon satisfactory performance evaluations by the Agency, are subject to the availability of funds, and optional to the Agency. “Delete” if a pre-calculated capitated rate contract. Pursuant to Chapter 2010-151, Laws of Florida, Section 47, the Agency shall review existing contract renewals and re-procurements with the Vendor in an effort to reduce contract payments by at least 3 percent (3%), but not affect the level and quality of services.

5. The Vendor agrees that the Agency may unilaterally cancel this Contract for refusal by the Vendor to allow public access to all documents, papers, letters, or other material made or received by the Vendor in conjunction with this Contract, unless the records are exempt from Section 24(a) of Art. I of the State Constitution and Section 119.07(1), Florida Statutes.

6. To comply with Patents, Royalties, Copyrights, Right to Data, and Works for Hire/Software requirements as follows:

The Vendor, without exception, shall indemnify and hold harmless the Agency and its employees from liability of any nature or kind, including cost and expenses for or on account of any copyrighted, patented, or unattended invention, process, or article manufactured or supplied by the Vendor. The Vendor has no liability when such claim is solely and exclusively due to the combination, operation or use of any article supplied hereunder with equipment or data not supplied by the Vendor or is based



solely and exclusively upon the Agency’s alteration of the article.

The Agency shall provide prompt written notification of a claim of copyright or patent infringement and shall afford the Vendor full opportunity to defend the action and control the defense. Further, if such a claim is made or is pending, the Vendor may, at its option and expense procure for the Agency the right to continue the use of, replace or modify the article to render it non-infringing (if none of the alternatives is reasonably available, the Agency agrees to return the article on request to the Vendor and receive reimbursement, if any, as may be determined by a court of competent jurisdiction).

If the Vendor brings to the performance of this Contract a pre-existing patent, patent-pending and/or copyright at the time of Contract execution, the Vendor shall retain all rights and entitlements to that pre-existing patent, patent-pending and/or copyright, unless this Contract provides otherwise.

If the Vendor uses any design, device, or materials covered by letter, patent, or copyright, it is mutually agreed and understood without exception that the proposed prices shall include all royalties or cost arising from the use of such design, device, or materials in any way involved in the work. Prior to the initiation of services under this Contract, the Vendor shall disclose, in writing, all intellectual properties relevant to the performance of this Contract which the Vendor knows, or should know, could give rise to a patent or copyright. The Vendor shall retain all rights and entitlements to any pre-existing intellectual property which is so disclosed. Failure to disclose will indicate that no such property exists. The Agency shall then have the right to all patents and copyrights which arise as a result of performance under this Contract as provided in this section.

If any discovery or invention arises or is developed in the course of, or as a result of, work or services performed under this Contract, or in any way connected herewith, the Vendor shall refer the discovery or invention to the Agency for a determination whether patent protection will be sought in the name of the State of Florida. Any and all patent rights accruing under or in connection with the performance of this Contract are hereby reserved to the State of Florida. All materials to which the Agency is to have patent rights or copyrights shall be marked and dated by the Vendor in such a manner as to preserve and protect the legal rights of the Agency.

Where activities supported by this Contract produce original writing, sound recordings, pictorial reproductions, drawings or other graphic representation and works of any similar nature, the Agency has the right to use, duplicate and disclose such materials in whole or in part, in any manner, for any purpose whatsoever and to have others acting on behalf of the Agency to do so. If the materials so developed are subject to copyright, trademark, or patent, legal title and every right, interest, claim, or demand of any kind in and to any patent, trademark or copyright, or application for the same, shall vest in the State of Florida, Department of State for the exclusive use and benefit of the state. Pursuant to Section 286.021, Florida Statutes, no person, firm, corporation, including parties to this Contract shall be entitled to use the copyright, patent, or trademark without the prior written consent of the Florida Department of State.



The Agency shall have unlimited rights to use, disclose, or duplicate, for any purpose whatsoever, all information and data developed, derived, documented, or furnished by the Vendor under this Contract. All rights and title to works for hire under this Contract, whether patentable or copyrightable or not, shall belong to the Agency and shall be subject to the terms and conditions of this Contract.

The computer programs, materials and other information furnished by the Agency to the Vendor hereunder shall be and remain the sole and exclusive property of the Agency, free from any claim or right of retention by or on behalf of the Vendor. The services and products listed in this Contract shall become the property of the Agency upon the Vendor’s performance and delivery thereof. The Vendor hereby acknowledges that said computer programs, materials and other information provided by the Agency to the Vendor hereunder, together with the products delivered and services performed by the Vendor hereunder, shall be and remain confidential and proprietary in nature to the extent provided by Chapter 119, Florida Statutes, and that the Vendor shall not disclose, publish or use same for any purpose other than the purposes provided in this Contract; however, upon the Vendor first demonstrating to the Agency’s satisfaction that such information, in part or in whole, (1) was already known to the Vendor prior to its receipt from the Agency; (2) became known to the Vendor from a source other than the Agency; or (3) has been disclosed by the Agency to third parties without restriction, the Vendor shall be free to use and disclose same without restriction. Upon completion of the Vendor’s performance or otherwise cancellation or termination of this Contract, the Vendor shall surrender and deliver to the Agency, freely and voluntarily, all of the above-described information remaining in the Vendor's possession.

The Vendor warrants that all materials produced hereunder will be of original development by the Vendor and will be specifically developed for the fulfillment of this Contract and will not knowingly infringe upon or violate any patent, copyright, trade secret or other property right of any third party, and the Vendor shall indemnify and hold the Agency harmless from and against any loss, cost, liability or expense arising out of any breach or claimed breach of this warranty. The terms and conditions specified in this section shall also apply to any subcontract made under this Contract. The Vendor shall be responsible for informing the subcontractor of the provisions of this section and obtaining disclosures.

7. The financial consequences that the Agency must apply if the Vendor fails to perform in accordance with this Contract are outlined in Attachment I, Scope of Services.

N. Sponsorship

Pursuant to Section 286.25, Florida Statutes, any nongovernmental organization which sponsors a program financed partially by state funds or funds obtained from a state agency shall, in publicizing, advertising, or describing the sponsorship of the program, state:



“Sponsored by and the State of Florida, AGENCY FOR HEALTH CARE ADMINISTRATION.” If the sponsorship reference is in written material, the words "State of Florida, AGENCY FOR HEALTH CARE ADMINISTRATION" shall appear in the same size letters or type as the name of the organization.

O. Final Invoice The Vendor must submit the final invoice for payment to the Agency no more

than days after the Contract ends or is terminated. If the Vendor fails to do so, all right to payment is forfeited and the Agency will not honor any requests submitted after the aforesaid time period. Any payment due under the terms of this Contract may be withheld until all reports due from the Vendor and necessary adjustments thereto have been approved by the Agency.

P. Use Of Funds For Lobbying Prohibited

To comply with the provisions of Section 216.347, Florida Statutes, which

prohibits the expenditure of Contract funds for the purpose of lobbying the Legislature, the judicial branch or a state agency.

Q. Public Entity Crime

A person or affiliate who has been placed on the convicted vendor list

following a conviction for a public entity crime may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, Florida Statutes, for category two, for a period of 36 months from the date of being placed on the convicted vendor list.

R. Health Insurance Portability and Accountability Act

To comply with the Department of Health and Human Services Privacy

Regulations in the Code of Federal Regulations, Title 45, Sections 160 and 164, regarding disclosure of protected health information as specified in Attachment II, Business Associate Agreement.

S. Confidentiality of Information

Not to use or disclose any confidential information, including social security

numbers that may be supplied under this Contract pursuant to law, and also including the identity or identifying information concerning a Medicaid recipient or services under this Contract for any purpose not in conformity with state and federal laws, except upon written consent of the recipient, or his/her guardian.

T. Employment

To comply with Section 274A (e) of the Immigration and Nationality Act. The

Agency shall consider the employment by any contractor of unauthorized aliens a violation of this Act. If the Vendor knowingly employs unauthorized



aliens, such violation shall be cause for unilateral cancellation of this Contract. The Vendor shall be responsible for including this provision in all subcontracts with private organizations issued as a result of this Contract.

U. Work Authorization Program

The Immigration Reform and Control Act of 1986 prohibits employers from

knowingly hiring illegal workers. The Vendor shall only employ individuals who may legally work in the United States – either U.S. citizens or foreign citizens who are authorized to work in the U.S. The Vendor shall use the U.S. Department of Homeland Security’s E-Verify Employment Eligibility Verification system, https://e-verify.uscis.gov/emp, to verify the employment eligibility of all new employees hired by the Vendor during the term of this Contract and shall also include a requirement in its subcontracts that the subcontractor utilize the E-Verify system to verify the employment eligibility of all new employees hired by the subcontractor performing work or providing services pursuant to this Contract. “Include” for contracts $1,000,000 or more

V. Scrutinized Companies Lists

The Vendor shall complete Attachment V, Vendor Certification Regarding Scrutinized Companies List, certifying that it is not listed on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, created pursuant to section 215.473, Florida Statutes (F.S.). Pursuant to section 287.135(5), F.S., the Vendor agrees the Agency may immediately terminate this Contract for cause if the Vendor is found to have submitted a false certification or if the Vendor is placed on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List during the term of the Contract.

II. THE AGENCY HEREBY AGREES:

A. Contract Amount

To pay for contracted services according to the conditions of Attachment I, Scope of Services, in an amount not to exceed $ , subject to the availability of funds. (Include specific funding appropriation if state funds is in excess of $5M in the first year of the contract). “Funding for this Contract is appropriated in …..”) The State of Florida's performance and obligation to pay under this Contract is contingent upon an annual appropriation by the Legislature.

B. Contract Payment

Section 215.422, Florida Statutes, provides that agencies have five (5)

working days to inspect and approve goods and services, unless bid specifications, Contract or purchase order specifies otherwise. With the exception of payments to health care providers for hospital, medical, or other health care services, if payment is not available within forty (40) days, measured from the latter of the date the invoice is received or the goods or services are received, inspected and approved, a separate interest penalty set by the Comptroller pursuant to Section 55.03, F.S., will be due and payable in addition to the invoice amount. To obtain the applicable interest rate, please contact the Agency’s Fiscal Section at (850) 412-3901, or utilize

https://e-verify.uscis.gov/emp



the Department of Financial Services website at www.myfloridacfo.com/aadir/interest.htm. Payments to health care providers for hospital, medical or other health care services, shall be made not more than thirty-five (35) days from the date eligibility for payment is determined, and the daily interest rate is .0003333%. Invoices returned to a vendor due to preparation errors will result in a payment delay. Invoice payment requirements do not start until a properly completed invoice is provided to the Agency. A Vendor Ombudsman, whose duties include acting as an advocate for vendors who may be experiencing problems in obtaining timely payment(s) from a State agency, may be contacted at (850) 413-5516 or by calling the State Comptroller’s Hotline, 1-800-848-3792.

III. THE VENDOR AND AGENCY HEREBY MUTUALLY AGREE:

A. Termination

1. Termination at Will

This Contract may be terminated by the Agency upon no less than thirty (30) calendar days written notice, without cause, unless a lesser time is mutually agreed upon by both parties. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery.

2. Termination Due To Lack of Funds

In the event funds to finance this Contract become unavailable, the Agency may terminate the Contract upon no less than twenty-four (24) hours’ written notice to the Vendor. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery. The Agency shall be the final authority as to the availability of funds. The Vendor shall be compensated for all work performed up to the time notice of termination is received.

3. Termination for Breach

Unless the Vendor's breach is waived by the Agency in writing, the Agency may, by written notice to the Vendor, terminate this Contract upon no less than twenty-four (24) hours’ written notice. Said notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery. If applicable, the Agency may employ the default provisions in Chapter 60A-1.006(3), Florida Administrative Code.

Waiver of breach of any provisions of this Contract shall not be deemed to be a waiver of any other breach and shall not be construed to be a modification of the terms of this Contract. The provisions herein do not limit the Agency's right to remedies at law or to damages.

B. Contract Managers

1. The Agency’s Contract Manager’s contact information is as follows:



2. The Vendor’s Contract Manager’s contact information is as follows:

3. All matters shall be directed to the Contract Managers for appropriate action or disposition. A change in Contract Manager by either party shall be reduced to writing through an amendment or minor modification to this Contract by the Agency.

C. Renegotiation or Modification

1. Modifications of provisions of this Contract shall only be valid when they

have been reduced to writing and duly signed during the term of the Contract. The parties agree to renegotiate this Contract if federal and/or state revisions of any applicable laws, or regulations make changes in this Contract necessary.

2. The rate of payment and the total dollar amount may be adjusted

retroactively to reflect price level increases and changes in the rate of payment when these have been established through the appropriations process and subsequently identified in the Agency's operating budget.

D. Name, Mailing and Street Address of Payee

1. The name (Vendor name as shown on Page 1 of this Contract) and

mailing address of the official payee to whom the payment shall be made:

2. The name of the contact person and street address where financial and administrative records are maintained:

E. All Terms and Conditions

This Contract and its attachments as referenced herein contain all the terms

and conditions agreed upon by the Parties.



IN WITNESS THEREOF, the Parties hereto have caused this page

Contract, which includes any referenced attachments, to be executed by their undersigned officials as duly authorized. This Contract is not valid until signed and dated by both parties.

STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION

SIGNED

BY: SIGNED

BY:

NAME: NAME:

TITLE: TITLE:

DATE: DATE:

FEDERAL ID NUMBER (or SS Number for an individual): VENDOR FISCAL YEAR ENDING DATE: List of Attachments/Exhibits included as part of this Contract: Specify Letter/ Type Number Description Attachment I Scope of Services ( Pages) Attachment II Business Associate Agreement (4 Pages) Attachment III Lobbying Certification (1 Page) Attachment IV Debarment Certification (1 Page) Attachment V Vendor Certification Regarding Scrutinized Companies List (1 Page).



AHCA ITN 017-12/13, Exhibit C-11, Page 14 of 19 AHCA Form 2100-0017 (Rev. AUG 09)

BUSINESS ASSOCIATE AGREEMENT The parties to this Attachment agree that the following provisions constitute a business associate agreement for purposes of complying with the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This Attachment is applicable if the Vendor is a business associate within the meaning of the Privacy and Security Regulations, 45 C.F.R. 160 and 164. The Vendor certifies and agrees as to abide by the following: 1. Definitions. Unless specifically stated in this Attachment, the definition of the terms

contained herein shall have the same meaning and effect as defined in 45 C.F.R. 160 and 164. 1.a. Protected Health Information. For purposes of this Attachment, protected health

information shall have the same meaning and effect as defined in 45 C.F.R. 160 and 164, limited to the information created, received, maintained or transmitted by the Vendor from, or on behalf of, the Agency.

1.b. Security Incident. For purposes of this Attachment, security incident shall mean any

event resulting in computer systems, networks, or data being viewed, manipulated, damaged, destroyed or made inaccessible by an unauthorized activity. See National Institute of Standards and Technology (NIST) Special Publication 800-61, "Computer Security Incident Handling Guide,” for more information.

2. Applicability of HITECH and HIPAA Privacy Rule and Security Rule Provisions. As

provided by federal law, Title XIII of the American Recovery and Reinvestment Act of 2009 (ARRA), also known as the Health Information Technology Economic and Clinical Health (HITECH) Act, requires a Business Associate (Vendor) that contracts with the Agency, a HIPAA covered entity, to comply with the provisions of the HIPAA Privacy and Security Rules (45 C.F.R. 160 and 164).

3. Use and Disclosure of Protected Health Information. The Vendor shall not use or disclose protected health information other than as permitted by this Contract or by federal and state law. The Vendor will use appropriate safeguards to prevent the use or disclosure of protected health information for any purpose not in conformity with this Contract and federal and state law. The Vendor will implement administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of electronic protected health information the Vendor creates, receives, maintains, or transmits on behalf of the Agency.

4. Use and Disclosure of Information for Management, Administration, and Legal Responsibilities. The Vendor is permitted to use and disclose protected health information received from the Agency for the proper management and administration of the Vendor or to carry out the legal responsibilities of the Vendor, in accordance with 45 C.F.R. 164.504(e)(4). Such disclosure is only permissible where required by law, or where the


Vendor obtains reasonable assurances from the person to whom the protected health information is disclosed that: (1) the protected health information will be held confidentially, (2) the protected health information will be used or further disclosed only as required by law or for the purposes for which it was disclosed to the person, and (3) the person notifies the Vendor of any instance of which it is aware in which the confidentiality of the protected health information has been breached.

5. Disclosure to Third Parties. The Vendor will not divulge, disclose, or communicate

protected health information to any third party for any purpose not in conformity with this Contract without prior written approval from the Agency. The Vendor shall ensure that any agent, including a subcontractor, to whom it provides protected health information received from, or created or received by the Vendor on behalf of, the Agency agrees to the same terms, conditions, and restrictions that apply to the Vendor with respect to protected health information.

6. Access to Information. The Vendor shall make protected health information available in

accordance with federal and state law, including providing a right of access to persons who are the subjects of the protected health information in accordance with 45 C.F.R. 164.524.

7. Amendment and Incorporation of Amendments. The Vendor shall make protected health

information available for amendment and to incorporate any amendments to the protected health information in accordance with 45 C.F.R. 164.526.

8. Accounting for Disclosures. The Vendor shall make protected health information available

as required to provide an accounting of disclosures in accordance with 45 C.F.R. 164.528. The Vendor shall document all disclosures of protected health information as needed for the Agency to respond to a request for an accounting of disclosures in accordance with 45 C.F.R. 164.528.

9. Access to Books and Records. The Vendor shall make its internal practices, books, and

records relating to the use and disclosure of protected health information received from, or created or received by the Vendor on behalf of the Agency, available to the Secretary of the Department of Health and Human Services or the Secretary’s designee for purposes of determining compliance with the Department of Health and Human Services Privacy Regulations.

10. Reporting. The Vendor shall make a good faith effort to identify any use or disclosure of

protected health information not provided for in this Contract. 10a. To Agency. The Vendor will report to the Agency, within ten (10) business days

of discovery, any use or disclosure of protected health information not provided for in this Contract of which the Vendor is aware. The Vendor will report to the Agency, within twenty-four (24) hours of discovery, any security incident of which the Vendor is aware. A violation of this paragraph shall be a material violation of this Contract. Such notice shall include the identification of each individual whose unsecured protected health information has been, or is


reasonably believed by the Vendor to have been, accessed, acquired, or disclosed during such breach.

10b. To Individuals. In the case of a breach of protected health information discovered

by the Vendor, the Vendor shall first notify the Agency of the pertinent details of the breach and upon prior approval of the Agency shall notify each individual whose unsecured protected health information has been, or is reasonably believed by the Vendor to have been, accessed, acquired or disclosed as a result of such breach. Such notification shall be in writing by first-class mail to the individual (or the next of kin if the individual is deceased) at the last known address of the individual or next of kin, respectively, or, if specified as a preference by the individual, by electronic mail. Where there is insufficient, or out-of-date contract information (including a phone number, email address, or any other form of appropriate communication) that precludes written (or, if specifically requested, electronic) notification to the individual, a substitute form of notice shall be provided, including, in the case that there are 10 or more individuals for which there is insufficient or out-of-date contact information, a conspicuous posting on the Web site of the covered entity involved or notice in major print of broadcast media, including major media in the geographic areas where the individuals affected by the breach likely reside. In any case deemed by the Vendor to require urgency because of possible imminent misuse of unsecured protected health information, the Vendor may also provide information to individuals by telephone or other means, as appropriate.

10c. To Media. In the case of a breach of protected health information discovered by

the Vendor where the unsecured protected health information of more than 500 persons is reasonably believed to have been, accessed, acquired, or disclosed, after prior approval by the Agency, the Vendor shall provide notice to prominent media outlets serving the State or relevant portion of the State involved.

10d. To Secretary of Health and Human Services. The Vendor shall cooperate with the

Agency to provide notice to the Secretary of Health and Human Services of unsecured protected health information that has been acquired or disclosed in a breach. If the breach was with respect to 500 or more individuals, such notice must be provided immediately. If the breach was with respect to less than 500 individuals, the Vendor may maintain a log of such breach occurring and annually submit such log to the Agency so that it may satisfy its obligation to notify the Secretary of Health and Human Services documenting such breaches occurring in the year involved.

10e. Content of Notices. All notices required under this Attachment shall include the

content set forth Section 13402(f), Title XIII of the American Recovery and Reinvestment Act of 2009, except that references therein to a “covered entity” shall be read as references to the Vendor.


10f. Financial Responsibility. The Vendor shall be responsible for all costs related to the notices required under this Attachment.

11. Mitigation. Vendor shall mitigate, to the extent practicable, any harmful effect that is known

to the Vendor of a use or disclosure of protected health information in violation of this Attachment.

12. Termination. Upon the Agency’s discovery of a material breach of this Attachment, the Agency shall have the right to terminate this Contract.

12a. Effect of Termination. At the termination of this Contract, the Vendor shall return all protected health information that the Vendor still maintains in any form, including any copies or hybrid or merged databases made by the Vendor; or with prior written approval of the Agency, the protected health information may be destroyed by the Vendor after its use. If the protected health information is destroyed pursuant to the Agency’s prior written approval, the Vendor must provide a written confirmation of such destruction to the Agency. If return or destruction of the protected health information is determined not feasible by the Agency, the Vendor agrees to protect the protected health information and treat it as strictly confidential.

The Vendor has caused this Attachment to be signed and delivered by its duly authorized representative, as of the date set forth below.

Vendor Name:

__________________________________ __________________ Signature Date

__________________________________ Name and Title of Authorized Signer



AHCA ITN 017-12/13, Exhibit C-11, Page 18 of 19 AHCA Form 2100-0010 (Rev. OCT02)

CERTIFICATION REGARDING LOBBYING CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND COOPERATIVE AGREEMENTS

The undersigned certifies, to the best of his or her knowledge and belief, that: (1) No federal appropriated funds have been paid or will be paid, by or on behalf of the

undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a member of congress, an officer or employee of congress, or an employee of a member of congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement.

(2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of congress, an officer or employee of congress, or an employee of a member of congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, “Disclosure Form to Report Lobbying,” in accordance with its instructions.

(3) The undersigned shall require that the language of this certification be included in the award documents for all sub-awards at all tiers (including subcontracts, sub-grants, and contracts under grants, loans, and cooperative agreements) and that all sub-recipients shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. __________________________________________ _________________________________ Signature Date __________________________________________ _________________________________ Name of Authorized Individual Application or Contract Number ______________________________________________________________________________ Name and Address of Organization


AHCA ITN 017-12/13, Exhibit C-11, Page 19 of 19 AHCA Form 2100-0009 (JAN 03)

CERTIFICATION REGARDING

DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION CONTRACTS/SUBCONTRACTS

This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, signed February 18, 1986. The guidelines were published in the May 29, 1987, Federal Register (52 Fed. Reg., pages 20360-20369).

INSTRUCTIONS

1. Each Vendor whose contract/subcontract equals or exceeds $25,000 in federal monies must sign this certification prior to execution of each contract/subcontract. Additionally, Vendors who audit federal programs must also sign, regardless of the contract amount. The Agency for Health Care Administration cannot contract with these types of Vendors if they are debarred or suspended by the federal government.

2. This certification is a material representation of fact upon which reliance is placed when this contract/subcontract

is entered into. If it is later determined that the signer knowingly rendered an erroneous certification, the Federal Government may pursue available remedies, including suspension and/or debarment.

3. The Vendor shall provide immediate written notice to the contract manager at any time the Vendor learns that its

certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 4. The terms "debarred," "suspended," "ineligible," "person," "principal," and "voluntarily excluded," as used in this

certification, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the contract manager for assistance in obtaining a copy of those regulations.

5. The Vendor agrees by submitting this certification that, it shall not knowingly enter into any subcontract with a

person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this contract/subcontract unless authorized by the Federal Government.

6. The Vendor further agrees by submitting this certification that it will require each subcontractor of this

contract/subcontract, whose payment will equal or exceed $25,000 in federal monies, to submit a signed copy of this certification.

7. The Agency for Health Care Administration may rely upon a certification of a Vendor that it is not debarred,

suspended, ineligible, or voluntarily excluded from contracting/subcontracting unless it knows that the certification is erroneous.

8. This signed certification must be kept in the contract manager's contract file. Subcontractor's certifications must

be kept at the contractor's business location.

CERTIFICATION (1) The prospective Vendor certifies, by signing this certification, that neither he nor his principals

is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this contract/subcontract by any federal department or agency.

(2) Where the prospective Vendor is unable to certify to any of the statements in this certification,

such prospective Vendor shall attach an explanation to this certification. ______________________________________ ______________ Signature Date ____________________________________________________________ Name and Title of Authorized Signer

Jennifer Barrett - MyFlorida.com Exhibit F-5 SMMC LTC Population MMA Base Data Set Exhibit F-6 Data...

Documents

Transcript of Jennifer Barrett - MyFlorida.com Exhibit F-5 SMMC LTC Population MMA Base Data Set Exhibit F-6 Data...